Analyse de la prise en charge médicale et de l'impact économique des patients ayant présentés des coûts extrêmes dans un hôpital universitaire [Analysis of the medical management and the economic impact of patients who have represented extreme costs at a university hospital]

Les coûts de traitement de certains patients s'avèrent extrêmement élevés, et peuvent faire soupçonner une prise en charge médicale inadéquate. Comme I'évolution du remboursement des prestations hospitalières passe à des forfaits par pathologie, il est essentiel de vérifier ce point, d'essayer de déterminer si ce type de patients peut être identifié à leur admission, et de s'assurer que leur devenir soit acceptable. Pour les années 1995 et 1997. les coûts de traitement dépassant de 6 déviations standard le coût moyen de la catégorie diagnostique APDRG ont été identifiés, et les dossiers des 50 patients dont les coûts variables étaient les plus élevés ont été analysés. Le nombre total de patients dont I'hospitalisation a entraîné des coûts extrêmes a passé de 391 en 1995 à 328 patients en 1997 (-16%). En ce qui concerne les 50 patients ayant entraîné les prises en charge les plus chères de manière absolue, les longs séjours dans de multiples services sont fréquents, mais 90% des patients sont sortis de l'hôpital en vie, et près de la moitié directement à domicile. Ils présentaient une variabilité importante de diagnostics et d'interventions, mais pas d'évidence de prise en charge inadéquate. En conclusion, les patients qualifiés de cas extrêmes sur un plan économique, ne le sont pas sur un plan strictement médical, et leur devenir est bon. Face à la pression qu'exercera le passage à un mode de financement par pathologie, les hôpitaux doivent mettre au point un système de revue interne de I'adéquation des prestations fournies basées sur des caractéristiques cliniques, s'ils veulent garantir des soins de qualité. et identifier les éventuelles prestations sous-optimales qu'ils pourraient être amenés à délivrer. [Auteurs] Treatment costs for some patients are extremely high and might let think that medical care could have been inadequate. As hospital financing systems move towards reimbursement by diagnostic groups, it is essential to assess whether inadequate care is provided, to try to identify these patients upon admission, and make sure that their outcome is good. For the years 1995 and 1997, treatment costs exceeding by 6 standard deviations the average cost of their APDRG category were identified, and the charts of the 50 patients with the highest variable costs were analyzed. The total number of patients with such extreme costs diminished from 391 in 1995 to 328 in 1997 (-16%). For the 50 most expensive patients, long stays in several services were frequent, but 90% of these patients left the hospital alive, and about half directly to their home. They presented an important variation in diagnoses and operations, but no evidence for inadequate care. Thus, patients qualified as extreme from an economic perspective cannot be qualified as such from a medical perspective, and their outcome is good. To face the pressure linked with the change in financing system, hospitals must develop an internal review system for assessing the adequacy of care, based on clinical characteristics, if they want to guarantee good quality of care and identify potentially inadequate practice.

Analysis of transport costs for energy crops for use in biomass pyrolysis plant networks

Fast pyrolysis of biomass produces a liquid bio-oil that can be used for electricity generation. Bio-oil can be stored and transported so it is possible to decouple the pyrolysis process from the generation process. This allows each process to be separately optimised. It is necessary to have an understanding of the transport costs involved in order to carry out techno-economic assessments of combinations of remote pyrolysis plants and generation plants. Published fixed and variable costs for freight haulage have been used to calculate the transport cost for trucks running between field stores and a pyrolysis plant. It was found that the key parameter for estimating these costs was the number of round trips a day a truck could make rather than the distance covered. This zone costing approach was used to estimate the transport costs for a range of pyrolysis plants size for willow woodchips and baled miscanthus. The possibility of saving transport costs by producing bio-oil near to the field stores and transporting the bio-oil to a central plant was investigated and it was found that this would only be cost effective for large generation plants.

Can globalisation result in less efficient and more vulnerable industries?

Growing economic globalisation (a means of market extension) may increase the economic vulnerability of firms in modern industries, especially those in which firms experience substantial economies of scale. The possibility is explored that globalisation activates competitive pressures that forces firms into a situation where their leverage (fixed costs relative to variable costs, or overhead cost relative to operating costs or capital intensity) rises substantially. Consequently, they become increasingly vulnerable to a sudden adverse change in economic conditions, such as a collapse in the demand for their industry’s product. This is explored for monopolistically competitive markets and also for oligopolistic markets of the type considered and modelled by Sweezy using kinked demand curves. In addition, globalisation is hypothesised to induce firms to become more uniformly efficient. While this has static efficiency advantages, this lack of heterogeneity in productive efficiency of firms can make for economic inefficiency in the adjustment of the industry to altered economic conditions. It is shown that lack of variation in the economic efficiency of firms can impede the speed of market adjustment to new equilibria and may destabilise market equilibria.

Planeamento de curto prazo de sistemas de energia solar usando técnicas de otimização robusta

Dissertação para obtenção do grau de Mestre em Engenharia Electrotécnica

Self-scheduling and bidding strategies of thermal units with stochastic emission constraints

This paper is on the self-scheduling problem for a thermal power producer taking part in a pool-based electricity market as a price-taker, having bilateral contracts and emission-constrained. An approach based on stochastic mixed-integer linear programming approach is proposed for solving the self-scheduling problem. Uncertainty regarding electricity price is considered through a set of scenarios computed by simulation and scenario-reduction. Thermal units are modelled by variable costs, start-up costs and technical operating constraints, such as: forbidden operating zones, ramp up/down limits and minimum up/down time limits. A requirement on emission allowances to mitigate carbon footprint is modelled by a stochastic constraint. Supply functions for different emission allowance levels are accessed in order to establish the optimal bidding strategy. A case study is presented to illustrate the usefulness and the proficiency of the proposed approach in supporting biding strategies. (C) 2014 Elsevier Ltd. All rights reserved.

The impact of changing the transportation cost structure of a food retail company

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Less frequent dosing of erythropoiesis stimulating agents in patients undergoing dialysis: a European multicentre cost study.

OBJECTIVE: To calculate the variable costs involved with the process of delivering erythropoiesis stimulating agents (ESA) in European dialysis practices. METHODS: A conceptual model was developed to classify the processes and sub-processes followed in the pharmacy (ordering from supplier, receiving/storing/delivering ESA to the dialysis unit), dialysis unit (dose determination, ordering, receipt, registration, storage, administration, registration) and waste disposal unit. Time and material costs were recorded. Labour costs were derived from actual local wages while material costs came from the facilities' accounting records. Activities associated with ESA administration were listed and each activity evaluated to determine if dosing frequency affected the amount of resources required. RESULTS: A total of 21 centres in 8 European countries supplied data for 142 patients (mean) per hospital (range 42-648). Patients received various ESA regimens (thrice-weekly, twice-weekly, once-weekly, once every 2 weeks and once-monthly). Administering ESA every 2 weeks, the mean costs per patient per year for each process and the estimates of the percentage reduction in costs obtainable, respectively, were: pharmacy labour (10.1 euro, 39%); dialysis unit labour (66.0 euro, 65%); dialysis unit materials (4.11 euro, 61%) and waste unit materials (0.43 euro, 49%). LIMITATION: Impact on financial costs was not measured. CONCLUSION: ESA administration has quantifiable labour and material costs which are affected by dosing frequency.

A model of conglomeration and synergy traps

We present a model of conglomeration motivated by technology synergies and strategic reductions in variable costs in the face of competitive pressures. The resulting firm integration is neither horizontal nor vertical but rather congeneric integration of firms in related industries. We endogenize the industrial conglomeration structure and examine the effects of competition between conglomerates, and between a conglomerate and independent firms. We show that there is an equilibrium synergy trap in which conglomerates are formed to exploit economies of scope, but resulting profits are lower than under the status quo. We also show that strategic firm integration can occur even in the presence of diseconomies of scope. The model helps to explain features of recent mergers and acquisitions experience.

Cost stickiness revisited: Empirical aplication for farms

This article reviews previous research regarding cost stickiness and performs an empirical analysis applied to a sample of farms. It recognizes that modelization of cost stickiness is a particular case of representation of cost variations as a function of output variations. It also discusses methodological issues and analyses cost stickiness for all registered farm costs and opportunity costs of family work. Costs exhibit a considerable level of rigidity. Even for variable costs, a decrease in activity involves a lower decrease in costs than the amounts involved when activity increases. While registered indirect costs slightly decrease when activity decreases, opportunity costs always increase. The study provides empirical evidence that cost stickiness is significantly reduced with better management decision practices.

Cost stickiness revisited: Empirical aplication for farms

This article reviews previous research regarding cost stickiness and performs an empirical analysis applied to a sample of farms. It recognizes that modelization of cost stickiness is a particular case of representation of cost variations as a function of output variations. It also discusses methodological issues and analyses cost stickiness for all registered farm costs and opportunity costs of family work. Costs exhibit a considerable level of rigidity. Even for variable costs, a decrease in activity involves a lower decrease in costs than the amounts involved when activity increases. While registered indirect costs slightly decrease when activity decreases, opportunity costs always increase. The study provides empirical evidence that cost stickiness is significantly reduced with better management decision practices.

New Operation Model for Maintenance Material Logistics in Paper Industry

This research report illustrates and examines new operation models for decreasing fixed costs and transforming them into variable costs in the field of paper industry. The report illustrates two cases - a new operation model for material logistics in maintenance and an examination of forklift truck fleet outsourcing solutions. Conventional material logistics in maintenance operation is illustrated and some problems related to conventional operation are identified. A new operation model that solves some of these problems is presented including descriptions of procurement and service contracts and sources of added value. Forklift truck fleet outsourcing solutions are examined by illustrating the responsibilities of a host company and a service provider both before and after outsourcing. The customer buys outsourcingservices in order to improve its investment productivity. The mechanism of how these services affect the customer company's investment productivity is illustrated.

Tehdaslogistiikka : value added logistics of the supply and demand chain costfix

VALOSADE (Value Added Logistics in Supply and Demand Chains) on Lappeenrannan teknillisen yliopiston ja sielläprofessori Anita Lukan VALORE -tutkimusryhmän toteuttama tutkimusprojekti, jonka rahoittaja on ollut Tekes. Projekti on osa Tekesin ELO - Elektronisen liiketoiminnan logistiikka - teknologiaohjelmaa. Tutkimusta rahoittivat Tekesin lisäksi neljä yritystä, jotka toimivat myös tutkimustyön kohteina ja toimivat tarpeen mukaan yhteistyössä tutkijoiden kanssa. Yritysten toimialat ovat metsäteollisuus, laitevalmistaja, joka tarjoaa myös tuotteilleen jälkimarkkinapalveluja sekä kaksi logistiikkapalveluyritystä. Tämä työraportti liittyy VALOSADE - tutkimusprojektin osaprojektiin Costfix (Paper Mill Process - from Fixed Costs into Variable Costs). Costfix - projektin tavoitteena on tutkia ja löytää paperiteollisuudelle uusia toimintamalleja, jotka mahdollistavat kiinteiden kustannusten muuttamisen muuttuviksi. Merkittävä tutkimuksen osa-alue on myös tutkimuskohteiden liike-toiminnan nykytilan aiempaa tarkempi selvittäminen. Tämä työraportti käsittelee kunnossapidon materiaalilogistiikan osalta tehtaan sisällä tapahtuvaa toimintaa, josta tässä tutkimuksessa käytetään nimitystä tehdaslogistiikka. Nykytilaselvityksen perusteella nykyinen prosessiteollisuudessa ja myös pääsääntöisesti valmistavassa teollisuudessa yleisesti vallitseva teollisuusyrityksen käyttöinvestointia ylläpitävän palveluprosessin toimintarakenne, johtamistapa ja prosessin operatiivisten tehtävien toimenkuvat eivät tue ko. palvelukokonaisuuden tehokasta ja tuloksellista toteuttamista. Nykymuotoinen toimintamalli pikemminkin rajoittaa toimintaprosessin kokonaishallintaa ja sen tehostamiseksi investoitujen uusien teknisten ratkaisujen ja teknologian käyttöönottoa. Lisäksi yleisesti vallitseva toimintakulttuuri (mm. arvokäsitykset, uskomukset sekä toiminnan ja tavoitteiden taustalla olevat motiivit) sekä vaikeuttaa nykyisen ja tulevan kilpailutilanteen edellyttämien tehokkuus- ja tuottavuustavoitteiden toteutumista että hidastaa uudistusten onnistumista edellyttävän muutoksen etenemistä yrityksen sisällä. Tutkimuksen tulokset vahvistivat osaltaan sen, että tehdas- ja toimintokeskeinen johtaminen aiheuttavat palveluprosessin eri tehtäville asetettujen tavoitteiden ja perustehtäväkäsityksen välille ristiriitoja, joista seuraa sekä suoria että välillisiä vaikutuksia teollisuusyrityksen tuotantoprosessin toiminnan laatuun ja tuotantolaitteiden käyttövarmuuteen. Palvelukokonaisuuteen kuuluvien eri toimintaprosessien tehtävät on jaettu ristiriitaisesti toiminnoille siten, että erityisestikunnossapidon teknisten toimihenkilöitten hoidettavana on sekä ihmisen henkilökohtaisen kapasiteettirajan ylittävä että toisistaan liian suuri erilaisia osaamisia ja ymmärrystä edellyttävä tehtävämäärä. Nykytilan palvelutuotannossa esiintyvien ongelmien seuraukset ja perussyyt osoittavat, että merkittävästi pääomia sitovan valmistavan teollisuuden (mm. prosessiteollisuus) käyttö-omaisuutta ylläpitävän palveluprosessin hallinta on ulkoistettava tehdastasolta itsenäisesti hoidettavaksi liiketoimintakokonaisuudeksi, jonka operatiivinen johtaminen tapahtuu toimintaprosesseittain konsernin ylätasolta käsin. Johtamismallissa painottuu prosessijohtaminen ja oman vastuualueen toimintaprosessin asiantuntemus. Lisäksi ihmisen osaamiseen, ymmärrykseen ja toimintatapaan perustuva palvelu edellyttää johtamiselta henkilöjohtamistaitoa ja osaamisen johtamista. Liiketoiminnan uudenlainen keskittyminen, verkostoituminen ja globalisoituminen edellyttävät johdoltamyös erilaisten toimintaverkostojen ja sidosryhmien toiminnan ja tarpeen ymmärtämistä. Tutkimustulosten perusteella myös palveluprosesseissa toimivien toimihenkilöitten tehtäväkuvia on muutettava radikaalisti ja osa uusista toimenkuvista edellyttää lisäksi henkilöitten osaamistason aktiivista parantamista. Tässä raportissa esitetään toimintamalli, jossa kuvataan tutkimuksen pohjalta luotu palvelukokonaisuuden johtamismalli ja palveluprosessien eri tehtävätasot tehtävineen. Kuvattu johtamismalli on ollut jo yleisesti käytössä yksittäisillä palvelualoilla, mutta tässä esitetty malli on valmistavan yrityksen teknisiin tukipalveluihin muokattu sovellus.

Kaukolämpöliiketoiminnan kustannusanalyysi

Diplomityössä selvitettiin Kuopion Energian kaukolämpöliiketoiminnan kustannusten muodostumista. Tilikartan toimivuutta ja kustannusvastaavuuden toteutumista tarkasteltiin kaukolämpöosaston näkökulmasta. Työssä laaditussa raportointisovelluksessa kustannukset jaoteltiin lämmön hankinnan, jakelun ja myyntitoiminnan kesken. Lisäksi tehtiin jako kiinteisiin ja muuttuviin kustannuksiin. Tällä tarkastelulla selvitettiin, vastaavatko perusmaksujen tulot kiinteitä kustannuksia ja energiamaksujen tulot muuttuvia kustannuksia. Energiamarkkinoiden vapautumista tarkasteltiin kaukolämpöliiketoiminnan näkökulmasta. Energiamarkkinavirasto on kehittänyt valvontamallin sähköverkkoliiketoiminnan kohtuullisen tuoton mittaamiseksi. Diplomityössä tarkasteltiin mallin soveltamismahdollisuuksia kaukolämpötoimintaan ja selvitettiin Kuopion Energian kaukolämpöliiketoiminnan tuoton kohtuullisuutta.

Ship Leases under IAS 17, case Fortum Shipping

International accounting standards will be applied from the1st of January 2005 in accounting of member states of the EU with a view of harmonizing the accounting practices in Europe, and on the long term even more widely. The purpose of adopting IAS accounting standards is to make the financial statements and financial information received from companies more comparable and more transparent for investors and other interest groups. IAS 17 introduces the treatment of a lease agreement in the light of the new accounting standards. Finnish companies have used finance leases widely as an alternative, off-balance sheet form of financing capital investments consistently with Finnish GAAP. Along with the appliance of IAS 17 the off-balance-sheet financing possibility of leases classified as finance leases will no longer exist. IAS 17 states that finance leases are going to be recognized in the balance sheet as both assets, in form of fixed assets, and loans in liabilities classified as long and short term loans. IAS 17 will make two major changes to the income statement. Firstly, the lease payments formerly treated as variable costs are moved below the operating profit level to finance costs. Secondly, the depreciations from the leased assets are also introduced. The effects to the case company's, Fortum Shipping's, income statement and balance sheet are remarkable. Along with the appliance of IAS Fortum Shipping's net assets are somewhat going to be doubled, the amount of liabilities increases significantly and the earnings before interests and taxes increases moderately. The preceding factors have a big effect on the case company's financial key figures. So, the IAS originated effects on balance sheet and income statement have essential impacts on a company's key financial indicators. Most significant changes can be found in key ratios measuring profitability, capital structure, and efficiency. This means that when comparing the IAS calculated profits of companies with the profits calculated prior with Finnish GAAP, the analysis should be made with prudence because the figures are not comparable on straight-forward basis.