Technological adoption in health care - The role of payment systems

This paper examines the incentive to adopt a new technology given by some popular reimbursement systems, namely cost reimbursement and DRG reimbursement. Adoption is based on a cost-benefit criterion. We find that retrospective payment systems require a large enough patient benefit to yield adoption, while under DRG, adoption may arise in the absence of patients benefits when the differential reimbursement for the old vs. new technology is large enough. Also, cost reimbursement leads to higher adoption under some conditions on the differential reimbursement levels and patient benefits. In policy terms, cost reimbursement system may be more effective than a DRG payment system. This gives a new dimension to the discussion of prospective vs. retrospective payment systems of the last decades centered on the debate of quality vs. cost containment.

Establishing a cell biology platform: isolation and preservation of human blood products

Dissertação para obtenção do Grau de Mestre em Genética Molecular e Biomedicina

A solution for estimates in software development projects

The Corporate world is becoming more and more competitive. This leads organisations to adapt to this reality, by adopting more efficient processes, which result in a decrease in cost as well as an increase of product quality. One of these processes consists in making proposals to clients, which necessarily include a cost estimation of the project. This estimation is the main focus of this project. In particular, one of the goals is to evaluate which estimation models fit the Altran Portugal software factory the most, the organization where the fieldwork of this thesis will be carried out. There is no broad agreement about which is the type of estimation model more suitable to be used in software projects. Concerning contexts where there is plenty of objective information available to be used as input to an estimation model, model-based methods usually yield better results than the expert judgment. However, what happens more frequently is not having this volume and quality of information, which has a negative impact in the model-based methods performance, favouring the usage of expert judgement. In practice, most organisations use expert judgment, making themselves dependent on the expert. A common problem found is that the performance of the expert’s estimation depends on his previous experience with identical projects. This means that when new types of projects arrive, the estimation will have an unpredictable accuracy. Moreover, different experts will make different estimates, based on their individual experience. As a result, the company will not directly attain a continuous growing knowledge about how the estimate should be carried. Estimation models depend on the input information collected from previous projects, the size of the project database and the resources available. Altran currently does not store the input information from previous projects in a systematic way. It has a small project database and a team of experts. Our work is targeted to companies that operate in similar contexts. We start by gathering information from the organisation in order to identify which estimation approaches can be applied considering the organization’s context. A gap analysis is used to understand what type of information the company would have to collect so that other approaches would become available. Based on our assessment, in our opinion, expert judgment is the most adequate approach for Altran Portugal, in the current context. We analysed past development and evolution projects from Altran Portugal and assessed their estimates. This resulted in the identification of common estimation deviations, errors, and patterns, which lead to the proposal of metrics to help estimators produce estimates leveraging past projects quantitative and qualitative information in a convenient way. This dissertation aims to contribute to more realistic estimates, by identifying shortcomings in the current estimation process and supporting the self-improvement of the process, by gathering as much relevant information as possible from each finished project.

Modelos de sistemas de financiamento dos cuidados de saúde: o impacto nos custos

Ao longo das últimas décadas tem-se verificado um crescente aumento dos custos de saúde na generalidade dos países e, em particular, nos países desenvolvidos. Este facto tem suscitado o aumento de estudos sobre os determinantes dos custos de saúde, bem como uma crescente preocupação por parte dos decisores políticos. No cerne da discussão está a importância da organização e do modelo de financiamento dos sistemas de saúde, de forma a promover a eficiência e a assegurar o acesso equitativo aos cuidados de saúde. A presente dissertação procura analisar a evolução dos custos com a saúde dos 15 países mais antigos da União Europeia, da Suíça e dos Estados Unidos da América, entre o período de 2000 e 2013. Os objetivos principais deste trabalho são os de compreender os aspetos gerais dos modelos de financiamento de saúde presentes concentrando-nos na questão das fontes de financiamento para analisar o impacto que estas têm nos custos de saúde dos países, nomeadamente no montante de custos e na sua evolução recente. Os resultados deste estudo sugerem que o crescimento do PIB se encontra associado ao aumento dos gastos de saúde, culminando com as conclusões propostas por estudos anteriores. A evidência sobre o impacto do envelhecimento das populações não é conclusiva. A forma como os sistemas de saúde dos diferentes países são organizados e financiados, também influenciam a evolução dos custos de saúde.

Corte térmico: orçamentação de produtos e racionalização do processo

Dissertação de mestrado integrado em Engenharia Mecânica

Implementação do sistema de custeio baseado em actividades (CBA) numa Instituição de Ensino Superior em Cabo Verde

Actualmente, a gestão de gastos assume um papel fundamental nas empresas modernas. A globalização, aliada às novas tecnologias, exige que essas empresas sejam ágeis e competentes. Neste contexto, a gestão eficiente dos recursos e a obtenção de informações precisas que apoiem na tomada de decisão, dependerão em grande parte, de um sistema de custo. A utilização de diversas tecnologias e ferramentas faz com que as empresas tenham cada vez mais gastos indiretos relativamente aos gastos diretos. Logo, o método CBA surgiu como alternativa aos sistemas de custeio tradicionais numa tentativa de solucionar ou, pelo menos, minimizar o problema de atribuição dos gastos indiretos. O presente trabalho pretende abordar o método CBA e propor uma metodologia de implementação do sistema numa Instituição de Ensino Superior, evidenciando e discutindo as principais vantagens e desvantagens associadas a esta metodologia e identificando as suas contribuições para a gestão das IES. De acordo com as pesquisas feitas, conclui-se que nenhuma das IES em São Vicente possui um sistema de contabilidade de gestão, mas verificou-se que todas têm conhecimento deste sistema e consideram-no o melhor método de gestão para análise dos gastos. Os resultados obtidos no estudo de caso demonstram que o objetivo foi atingido, apurandose que o método CBA é o mais adequado para o suporte à gestão, tendo em conta que ultrapassa as insuficiências de informação sobre os gastos. Currently, cost management plays a key role in modern business. The globalization, allied to the new technologies, demands that those companies are agile and qualified. In this context, an efficient management of the resources and the gathering of precise information which support the decision-making process will depend, largely, of an effective cost management system. The use of different technologies and tools makes companies have more indirect costs than direct. Therefore, the ABC method was devised as an alternative to the conventional means of costing in an attempt of solving or, at least, minimizing the problem of the attribution of indirect costs. Our work intends to analyze the ABC method and to propose a methodology of implementation of such system in an Institution of Higher Education, showing and discussing the main advantages and disadvantages associated with this methodology and identifying its contributions for the administration of these Institutions. Our research has shown that, none of the IHEs in São Vicente has a management accounting system, although all have knowledge of it and consider it as being the best administration method for the analysis of expenses. The results obtained in the case study demonstrate that the objective was reached: to conclude the ABC method is the most adequate to support the administration, as it overcomes the problem of lack of information on the running costs.

Implementação do abc (activity-based costing) numa empresa prestação de serviços de saúde

O presente trabalho cujo título é Implementação do ABC numa empresa prestadora de serviços de Saúde, tem como finalidade a obtenção do grau de licenciatura em Contabilidade e Administração e tem como principal objectivo a implementação do método ABC numa pequena e média empresa de prestação de serviços de saúde, como um instrumento de apoio á gestão. Para a introdução da Contabilidade de Gestão na empresa, há que se escolher um método/sistema de apuramento de gastos que espelha a realidade da empresa, e de uma certa forma o ABC é o método ideal para apuramento de resultados sem distorções. O ABC (Activity-Based Cost) apura os resultados através da relação de causa-efeito, considerando que as actividades é que geram gastos e os objectos de custeio é que consomem as actividades. É aplicável tanto nas empresas industriais como nas empresas prestadoras de serviços, apesar de inicialmente ter sido concebido para as empresas industrias, isto é, para as grandes empresas devido aos avultados recursos financeiros e humanos como também pelo tempo necessário para a sua implementação. Mas o modelo matricial apresentado por Roztcki et al (1999) permite a aplicação deste método nas PME com poucos recursos financeiros e de tempo, utilizando uma folha de cálculo no Excel. Será este modelo a ser proposto e poderá ser implementado na clínica. O modelo apresentado foi testado num estudo de caso realizado numa clínica. Com a realização dos testes foi detectado algumas dificuldades e limitações, as maiores dificuldades encontradas foram a identificação das actividades e dos cost drivers, devido à complexidade do sector. A implementação foi concluída com sucesso, proporcionando informações detalhadas dos gastos dos produtos/serviços prestados em toda a clínica. This work was done as a requisite for obtaining a degree in Accounting and Administration, and is titled “The Implementation of ABC – Activity Based Cost in a company that provides health services”. Its main purpose is to analyze the implementation of ABC method in a small and medium-sized enterprise which provides health services to support decision making by the Managers. To adopt management accounting in a company, it’s necessary to choose a cost qualifying system that reflects the reality of the company and in a certain way ABC is the method which can determine the results without any distortion. ABC (Activity-Based Cost) determines the results through cause-and-effect relationship, whereas the activities generate spending while costing objects consume the activities. It’s applicable both in industrial companies as in services providers, although it was initially designed for industrial companies, that is, to large companies, due to the huge financial and human resources existent as well as by the time required for its implementation. But the matrix model presented by Roztckiet al (1999) allows application of this method in small and medium-sized enterprises with limited financial resources and time, using a spreadsheet in Excel. This model will be proposed and could be implemented in any clinic. The model was tested in a case study, undertaken in a private clinic. With the realization of the tests, some problems and limitations were detected, and the major difficulties encountered were the identification of activities and cost drivers, due to the complexity of the sector. The implementation was completed successfully, providing detailed information of the products services spending throughout the clinic.

Swiss DRGs : patient heterogeneity and hospital payments

In this paper, we analyze the prospective method of paying hospitals when the within-DRG variance is high. To avoid patients dumping, an outlier payment system is implemented. In the APDRG Swiss System, it consists in a mixture of fully prospective payments for low costs patients and partially cost-based system for high cost patients. We show how the optimal policy depends on the degree to which hospitals take patients' interest into account. A fixed-price policy is optimal when the hospital is sufficiently benevolent. When the hospital is weakly benevolent, a mixed policy solving a trade-off between rent extraction, efficiency and dumping deterrence must be preferred. Following Mougeot and Naegelen (2008), we show how the optimal combination of fixed price and partially costbased payment depends on the degree of benevolence of the hospital, the social cost of public funds and the distribution of patients severity. [Authors]

Use of Longitudinal Subdrains in the 3R Program, Final Report, HR-509, 1981

Construction of the interstate highway system began in 1956. This U.S. network of highway consists of more than 41,000 miles with 790 miles in Iowa. There have been many benefits of the controlled access roadway, but probably the most significant is the improved safety for the motorist. In Iowa, we have always endeavored to utilize quality locally available materials in our construction using the most economical or cost effective methods. Obviously when the effort is to build a cost effective system, there will be some portions of the network that will not perform as well as expected. In the design of our interstate, the main consideration for base construction under the pavement was structural capacity. The material was dense graded with the aim of supporting the pavement and distributing the load as it is transferred to the underlying grade. The drainage characteristic of the base was apparently not given adequate consideration. On jointed portland cement concrete (pcc) pavement, the water that is trapped immediately beneath the pavement causes severe problems. The traffic causes rapid movement of the water resulting in the hydraulic pressures or "pumping" (movement and redeposit of base fine material) resulting in faulting between individual slabs. Recognizing the need for maintaining this large national highway network, the Federal Highway Administration has initiated a funding program for resurfacing, restoration and rehabilitation (3R). Many miles of the system are more than 20 years old and in need of major maintenance. This new 3R Program necessitated a complete inventory of the Iowa interstate system to establish priorities and to identify those sections in need of immediate remedial treatments.

Komposiittipakkausrakenteen valmistustekninen selvitys

Diplomityö on tehty Exel Oyj:lle tuotekehityprojektina. Tarkoituksena on kehittää Exel Oyj:n valmistamaa komposiittipakkausrakennetta. Työssä on keskitytty valmistustekniseen selvitykseen komposiittirakenteen teollisen mittakaavan tuotannossa. Työssä selvitettiin erilaisten tuoterakenteiden valmistettavuutta sekä suoritettiin kyseisen tuotteen vaatimusprofiilin mukaisia testejä valituille rakennevaihtoehdoille. Pakkausrakenteelle asetettuja vaatimuksia ovat mm. kuljetusvaatimukset, jotka määräytyvät lähinnä NATO standardien pohjalta. Lisäksi tuotteelta vaaditaan tiettyä pitkäaikaiskestoa käsittelyn kannalta sekä soveltuvuutta vallitseviin ilmasto-olosuhteisiin. Vaatimusten mukaisia ominaisuuksia tutkittiin lisäksi mm. ballistisilla ja mekaanisilla testeillä sekä kaasuläpäisytesteillä. Testien pohjalta voidaan todeta, etteivät perinteisen alipaineinjektoidun komposiittituotteen ballistiset ominaisuudet ole riittävällä tasolla suojatuotetta ajatellen. Ballististen ja mekaanisten testien kesken havaittiin joitain yhtäläisyyksiä ja tämä vaikuttaa olevan nimenomaan mekaanisesti optimoidun komposiitin ominaisuus. DI-työn lopputuloksena on saatu selkeä kuva pakkausrakenteen materiaalivaihtoehtojen soveltuvuudesta kyseiselle tuotteelle. Lisäksi pakkausrakenteelle on ehdotettu neljä erilaista tuotesuunnitelmaan, niiden valmistustekniikat sekä lopputuotteen kustannusarviointi.

Pientarvikkeidenkustannusten ja logistiikan hallinan kehittäminen

Tämän diplomityön keskeisenä päätavoitteena on luoda toimintamallivarustelutarvikkeiden kustannusten ja logistiikan hallinnalle. Päätavoite voidaan jakaa osatavoitteisiin, joita ovat tuotannon palvelutason parantaminen, kustannusten tarkempi kohdistaminen sekä kustannussäästöjen saavuttaminen. Työssä keskitytään kahden tavarantoimittajan toimittamiin varustelunimikkeisiin. Nimikkeistön analysoinnin perusteella valittiin uuteen toimintamalliinsopiva nimikkeistö. Teoriasta valittiin viitekehys, jonka ympärille uutta toimintamallia lähdettiin rakentamaan. Toimintamallin rungoksi valittiin VMI-malli eli täydennysyhteistyö. Lisäksi uuden toimintamallin rinnalle kehitettiin uusi kustannusten kohdistusmenetelmä. Tuotannon palvelutason voidaan katsoa parantuneen ja varaston sekä oston työmäärän vähentyneen jo työn aikana. Tiedon liikkuminen asiakkaan ja toimittajien välillä lisääntyi ja liiketoimintasuhteet tiivistyivät. Saatuja tuloksia verrattiin teorian ja tutkimuksen tuloksiin.

Kustannus- ja kannattavuusmallin rakentaminen projektiliiketoiminnan ohjausta varten nuoressa pk-yrityksessä

Tässä tutkielmassa selvitetään millainen yrityksen ensimmäisen kustannuslaskentajärjestelmän tulisi olla ja rakennetaan se kohdeyritykseen. Tutkimus on kvalitatiivinen casetutkimus, jonka tutkimusote on konstruktiivinen. Tutkielmassa selvitetään millaisia seikkoja on otettava huomioon kustannuslaskentajärjestelmää rakennettaessa. Tarkoituksena on selvittää miten erityisesti liiketoimintamalli (projektiliiketoiminta), yrityskoko (pieni) ja yrityksen ikä (nuori) vaikuttavat järjestelmän konfiguraatioon. Tutkimuksessa kootaan kustannuslaskentajärjestelmän rakentamisessa huomioitavista seikoista viitekehys. Tutkimuksessa selvisi, että kohdeyrityksen ensimmäisen kustannuslaskentajärjestelmän tulisi olla yksinkertainen, tuottaa oikeaa ja riittäväätietoa kustannuksista ja kannattavuuksista sekä projekti- että liiketoimintatasolla. Projektiliiketoiminnan kontekstissa järjestelmän on oltava joustava ja laskentakohteena tulee olla projektit. Nuoren iän ja pienen koon vuoksi talouden ohjauksen käytännöt vasta kehittyvät. Toiminnan kehittyminen ja ajankuluminen generoivat uusia talouden ohjauksen tarpeita.

Studies on coordination of systems development process

This thesis examines coordination of systems development process in a contemporary software producing organization. The thesis consists of a series of empirical studies in which the actions, conceptions and artifacts of practitioners are analyzed using a theory-building case study research approach. The three phases of the thesis provide empirical observations on different aspects of systemsdevelopment. In the first phase is examined the role of architecture in coordination and cost estimation in multi-site environment. The second phase involves two studies on the evolving requirement understanding process and how to measure this process. The third phase summarizes the first two phases and concentrates on the role of methods and how practitioners work with them. All the phases provide evidence that current systems development method approaches are too naïve in looking at the complexity of the real world. In practice, development is influenced by opportunity and other contingent factors. The systems development processis not coordinated using phases and tasks defined in methods providing universal mechanism for managing this process like most of the method approaches assume.Instead, the studies suggest that managing systems development process happens through coordinating development activities using methods as tools. These studies contribute to the systems development methods by emphasizing the support of communication and collaboration between systems development participants. Methods should not describe the development activities and phases in a detail level, butshould include the higher level guidance for practitioners on how to act in different systems development environments.

Voimalaitosten investointi- ja energiantuotantokustannusten arviointi

Investointi- ja energiantuotantokustannusten arviointi ja määrittäminen projektin alkuvaiheessa on olennainen osa voimalaitoksen elinkaaritiedon hallintaa. Tällöin tehdään investointi- ja energiantuotantokustannusten vertailua voimalaitosten kesken, joiden perusteella käytettävä voimalaitoskonsepti valitaan kompromissina toisaalta taloudellisen ja toisaalta suorituskyvyiltään tehokkaan voimalaitoksen väliltä. Koska investointikustannukset vaikuttavat suuresti energiatuotantokustannuksiin, on investointikustannusten arvioimisella suuri rooli voimalaitoskonseptia valittaessa. Investointikustannusten arviointimenetelmien käyttö eri projektivaiheissa riippuu pitkälti käytettävästä toteutuneesta kustannustiedosta sekä siitä, mihin tarkkuustasoon on kunkin projektin vaiheessa tarkoituksenmukaista pyrkiä. Suuren kustannusdatan avulla päästään vähilläkin lähtötiedoilla hyvään kustannusarvion tarkkuuteen. Projektin alkuvaiheessa ei kuitenkaan kannata uhrata liikaa aikaa kustannusarvion laatimiseen, koska arvioinnin kustannus kasvaa tarkkuuden myötä. Tässä työssä pyrittiin löytämään riippuvuussuhteita voimalaitosten kustannusten ja suoritusarvojen välille. Havaittujen riippuvuussuhteiden perusteella määritettiin in-vestointi- ja sähköntuotantokustannukset noin 50:lle voimalaitokselle. Investointi-kustannukset jaettiin 23:een kustannuskomponenttiin koneiden ja laitteiden sekä ra-kennusteknisten töiden kustannusryhmiin. Lisäksi kokonaisinvestointiin sisältyy projektikustannukset, rakennusaikaiset korot ja varaus. Laskettujen voimalaitosten avulla muodostettiin oma laskentaohjelmisto investointi- ja energiantuotantokustan-nusten arviointiin sekä talletukseen. Ohjelmistolla pyritään yhdenmukaistamaan kustannusarvioiden laadintaa samalla vähentäen arvioissa esiintyvää inhimillisen virheen todennäköisyyttä.

Kulujen seurantajärjestelmän suunnittelu ja toteutus telealan yrityksessä

Työssä kuvataan ne tietojärjestelmäprojektin vaiheet, joiden kautta Radiolinja Oy:ssä otettiin käyttöön uusi verkkovuokrauksen kulujen seurantajärjestelmä. Tarkastelun keskeisimmät osa-alueet ovat tavoitetilan ja järjestelmän suunnittelu, tarjouskierroksen vaiheet, sopimusneuvottelut järjestelmätoimittajan kanssa sekä järjestelmän toteutus ja käyttöönotto. Tietojärjestelmän hankintaprojektissa on tärkeintä suunnitelmallinen eteneminen ja tarkka tavoitetilan määrittely. Määrittelyn puutteet ovat sitä vaikeammat korjata, mitä pidemmälle projekti etenee. Tässä työssä tavoitetila määriteltiin loppukäyttäjiä haastattelemalla. Kulujen seurantajärjestelmälle asetetut tavoitteet dokumentoitiin ja liitettiin tarjouspyyntöön. Sopivan järjestelmätoimittajan kanssa käytyjen sopimusneuvottelujen jälkeen järjestelmä toteutettiin räätälöintityönä. Työn lopputuloksena otettiin käyttöön asetettuja tavoitteita vastaava kulujen seurantajärjestelmä. Projektin aikana ongelmia kohdattiin suunnitellun aikataulun ja budjettikehyksen pitämisessä, mikä johtui pääasiassa räätälöintityön luonteesta ja siihen kuluvan ajan vaikeasta arvioitavuudesta. Projektin vahvuutena sen sijaan oli sitoutunut ja oikein valittu loppukäyttäjistä muodostettu projektiryhmä.