Costs of Schizophrenia at Psychiatric Hospital of Bingerville (Ivory Coast)

Schizophrenia is classified as a priority mental disorder by the World Health Organization (WHO) and accounts for around 35% of diagnoses at the Bingerville Psychiatric Hospital (HPB). The aims of the study were to identify the cost drivers for hospitalization and to calculate the costs of managing schizophrenia in hospital, with a view to planning household expenditure on care. This pilot cross-sectional study involved 31 patients with schizophrenia who had been hospitalized in the various third-category wards at the HPB between 1st January 2019 and 31st May 2020. Sampling was accidental. The methods used to estimate costs were based on the actual costs of drugs, hospitalization and additional examinations which prices were known, and on patients’ estimations for certain expenses such as food and transport. Results: The sex ratio was 3.42, the mean age was 29.52 years. The mean length of stay was 46.19 days, and the most frequent clinical forms were paranoid schizophrenia (41.9%) and schizoaffective disorder (29%). The combination of haloperidol and chlorpromazine was the most common medications for initial treatment (67.8%) and maintenance treatment (41.9%). The average cost of hospitalization at HPB for schizophrenia was XOF 164,412 (€249.90). The average direct medical cost was XOF 105,412 (€160.226) and the average direct non-medical cost was XOF 59,000 (€89.68). The average daily cost of antipsychotic treatment was XOF 795/day (€1.2084). The high cost of drugs as a proportion of hospitalization costs suggested the need of a reflection on the simplification of prescribing practices, assistance in psychiatric emergencies and the development of other alternatives to psychiatric hospitalization in Côte d’Ivoire.

Analysis of Internal Control Management Problems in Hospital Finance and Accounting

This paper outlines the internal control management of hospital accounting and finance,introducing its concept,importance,and objectives.It then analyzes the problems existing in the internal control management of hospital accounting and finance,including an unsound management system,insufficient system implementation,inadequate risk assessment and control capabilities,poor information communication,weak internal supervision,and uneven personnel quality.The reasons for these problems are also analyzed,including outdated management concepts,irrational organizational structures,imperfect training and incentive mechanisms,low levels of information technology,and changes in the external environment.This paper proposes improvement measures for the internal control management of hospital accounting,including enhancing the management system,strengthening system implementation,improving risk assessment and control capabilities,enhancing the information communication mechanism,strengthening internal supervision,improving personnel quality,advancing information technology,and adapting to changes in the external environment.

Study on human resources cost accounting based on standards and general rules

The issue of the new standards for employees＇ salary and general financial rules that include employees＇ salary and relevant expenditures, have a great impact on human resources cost accounting. This paper performs a specialized study on human resources cost and employees＇ salary, accounts setting and accounting treatment for human resources cost accounting, human resources cost report, etc. on the basis of relevant provisions in the new Chinese accounting standards, the general financial rules, international accounting standards, and relevant academic research findings.

Higher cost of arthroplasty for hip fractures in patients transferred from outside hospitals vs primary emergency department presentation

BACKGROUND In 2016 Centers for Medicare and Medicaid Services proposed bundled payments for hip fractures to improve the quality and decrease costs of care.Patients transferred from other facilities may be imposing a financial risk on the hospitals that accept these patients.AIM To determine the costs associated with patients that either presented to the emergency department or were transferred from another hospital or skilled nursing facility(SNF)with the diagnosis of a hip fracture requiring operative intervention.METHODS A retrospective single institution review was conducted for all arthroplasty patients from 2010 to 2015.Inclusion criteria included a total or partial hip replacement for a hip fracture.Exclusion criteria included pathologic,periprosthetic,and fracture non-union.Data was collected to compare total observed costs for patients from the emergency department,patients from skilled nursing facilities,and patients from an outside hospital.RESULTS A total of 223 patients met the inclusion criteria.135(60.54%)of these patients presented primarily to the emergency department,58 patients(26.01%)were transferred from an outside hospital,and 30 patients(13.43%)were transferred from a SNF.Cost data analysis showed that outside hospital patients demonstrated significantly greater total cost for their hospitalization($43302)compared to emergency department patients($28875,P=0.000)and SNF patients($28282,P=0.000).CONCLUSION Patients transferred from an outside hospital incurred greater costs for their hospitalization than patients presenting from an emergency department or SNF.This is a strong argument for riskadjustment models when bundling payments for the care of hip fracture patients.

Linear Programs in Cost Accounting： A Linear Cost Model

This paper aims to find unit cost of a product for firms. It establishes a linear cost model to find unit cost. Linear goal programs assume a direct relationship between independent variable and dependent variable. Dependent variable of linear model is unit cost. Independent variables are cost accounting variables. They are supply cost, labor cost, and administration cost. This study assumes a direct relationship between supply-labor-administration costs and unit cost. Therefore, it establishes a linear cost model. The major research question of this study is to apply linear goal programming to cost accounting. The goal of this linear program is to find unit cost of product. This study uses quantitative method and human capital method. The main research result is linear costing model itself.

Developing Public Sector Cost Accounting Systems Case Finnish Defence Forces

This paper addresses the relationship between ＂new＂ and the ＂old＂ public performance management; the dialogue between imported idealistic designs and the inherently stable existing （performance） management systems （Carmona ＆ Gronlund, 2003; Hyvonen, Jairvinen, Pellinen, ＆ Rahko, 2009; Scapens ＆ Ter Bogt, 2009）. We see the co-existence of imported and traditional, both idealistic and realistic models of performance management as problematic. Such performance management models are based on different institutional logics that are the taken-for-granted rules guiding behavior of field-level actors, and related practices that predominate in an organizational field. These logics help to explain connections that create a sense of common purpose and unity within an organizational field （Scott, 2001; Kitchener, 2002）. The purpose of this paper is to analyze and illustrate how institutional pressures for management accounting change are formed. Most studies on change and stability of management accounting pay little attention on how institutional pressures for accounting change are formed, especially on the political field level. Our study demonstrates how various actors at the political field level participate in creating institutional pressures in diverse and sometimes contradictory ways. Drawing on archival data and 20 interviews with public officials, we seek to illustrate how different organizational field-level actors＇ views on implementing cost accounting differ, and how these views have influenced the outcome of cost accounting development in the Finnish Defence Forces. Our results suggest that contradictory institutional logics exist in relation with Finnish central government management-by-results, performance management and cost accounting systems. A value-for-money ideology in the armed forces sector （see e.g., Gr6nlund ＆ Catasus, 2005） at times seems to challenge and even contradict the ＂legalistic＂ tradition of developing cost accounting that conforms to budgetary laws and statues. Similarly, the New Public Management based performance prism model （Fryer, Antony, ＆ Ogden, 2009; Neely, Adams, ＆ Crowe, 2001）, when implemented at a local level, seems to conflict with notions common in accounting literature, according to which management accounting systems should be aligned with organizations＇ strategy and structure （see e.g., Abemethy, Lillis, Brownell, ＆ Carter, 2001）.

Comparison of Mortality, Length of Stay, and Hospitalization Costs of Hospitalized COVID-19 Patients with Cardiac and Non-Cardiac Disease

Background: The COVID-19 pandemic has presented unprecedented challenges to global healthcare systems. As the pandemic unfolded, it became evident that certain groups of individuals were at an elevated risk of experiencing severe disease outcomes. Among these high-risk groups, individuals with pre-existing cardiac conditions emerged as particularly vulnerable. Objective: This study aimed to investigate the relationship between the length of stay, mortality, and costs of COVID-19 patients with and without a history of cardiac disease. Design: This retrospective study was conducted in Jam Hospital in Tehran, Iran, from March 21, 2021, to March 21, 2022. All patients with laboratory-confirmed COVID-19 who were hospitalized during this period were included. Results: A total of 500 COVID-19 patients were hospitalized, with 31.6% having a history of cardiac disease and 68.4% without any cardiac disease. Patients with cardiac disease were significantly older (median [range] age, 69.35 [37 - 94] years) compared to non-cardiac patients (54.95 [13 - 97] years) (p Conclusion: Patients with cardiac disease who are hospitalized with COVID-19 have a higher mortality rate, longer hospital stays, greater disease severity, ICU admission, and higher costs. Therefore, improved prevention and management strategies are crucial for these patients.

Medical Direct Cost of Hospital Admission for Cerebrovascular Accident on Medical Recovery at the Sylvanus Olympio Teaching Hospital of Lomé

Objectives: Appreciate the Medical direct cost for cerebrovascular accident on medical recovery at the Sylvanus Olympio Teaching Hospital of Lomé. Patients and method: This was a prospective and cross study that took place from 01st October 2015 to 31st July 2016 in the medical recovery Unit of Sylvanus Olympio Teaching Hospital of Lomé. Results: Of the 91 stroke patients surveyed, the average age was 55.1 years;the sex-ratio (Men/women) was 1.3 and only 8.8% of patients had benefited from INAM (National Institute of Health Insurance) granting of benefits. The proportion of ICVA was 73.6% compared to 26.4% for the MCVA. The average overall cost of granting benefits of a CVA patient was 312,245 FCFA for an average stay of 18.6 days. This cost was 399.115 FCFA in MCVA for an average stay of 19.0 days against 281.130 FCFA in ICVA for an average stay of 16.1 days. Conclusion: CVAs on the one hand inflict losses of national productivity by its handicap, and a heavy economic burden for both patients and their families on the other hand, by its high cost of granting of benefits;Hence there is the need for assistance of all kinds by national and international health actors.

Analysis of hospitalization costs related to fall injuries in elderly patients

BACKGROUND With the aging world population,the incidence of falls has intensified and fallrelated hospitalization costs are increasing.Falls are one type of event studied in the health economics of patient safety,and many developed countries have conducted such research on fall-related hospitalization costs.However,China,a developing country,still lacks large-scale studies in this area.AIM To investigate the factors related to the hospitalization costs of fall-related injuries in elderly inpatients and establish factor-based,cost-related groupings.METHODS A retrospective study was conducted.Patient information and cost data for elderly inpatients(age≥60 years,n=3362)who were hospitalized between 2016 and 2019 due to falls was collected from the medical record systems of two grade-A tertiary hospitals in China.Quantile regression(QR)analysis was used to identify the factors related to fall-related hospitalization costs.A decision tree model based on the chi-squared automatic interaction detector algorithm for hospitalization cost grouping was built by setting the factors in the regression results as separation nodes.RESULTS The total hospitalization cost of fall-related injuries in the included elderly patients was 180479203.03 RMB,and the reimbursement rate of medical benefit funds was 51.0%(92039709.52 RMB/180479203.03 RMB).The medical material costs were the highest component of the total hospitalization cost,followed(in order)by drug costs,test costs,treatment costs,integrated medical service costs and blood transfusion costs The QR results showed that patient age,gender,length of hospital stay,payment method,wound position,wound type,operation times and operation type significantly influenced the inpatient cost(P<0.05).The cost grouping model was established based on the QR results,and age,length of stay,operation type,wound position and wound type were the most important influencing factors in the model.Furthermore,the cost of each combination varied significantly.CONCLUSION Our grouping model of hospitalization costs clearly reflected the key factors affecting hospitalization costs and can be used to strengthen the reasonable control of these costs.

Cost of Stroke Care at Public Hospitals in Brazzaville and Implication of Third Parties in Stroke Care Expenditure

Background: Among the main challenges of healthcare system throughout the world, there is stroke management. It is important to have data on the in-hospital costs of stroke care to help decision-makers to implement a health insurance system. Objectives: To evaluate the in-hospital costs of stroke care in Brazzaville;to determine the factors influencing the total mean in-hospital cost of stroke care;to identify third parties contributing to stroke care expenditure. Methods: This was a cross-sectional prospective and analytical study. It was carried out at 4 public hospitals in Brazzaville (University Hospital Center, Chinese and Congolese Friendship Hospital, Talanga&#239; Hospital and Makélékélé Hospital), from May to August 2019 (4 months). It focused on patients who had a first episode of stroke confirmed by brain imaging and were at least 18 years old. The bottom-up approach was used to determine the in-hospital costs of stroke care. Results: This study included 109 patients who fulfilled inclusion criteria. Their mean age was 59.2 ± 13.7 years old, with limits of 35 and 90 years old. The total direct in-hospital cost of stroke care was 47,308,330 francs CFA (72,122 euro). The total mean in-hospital cost of stroke care was 1,389,590 francs CFA (2118 euro). The mean cost of intracerebral hemorrhage care was 510,988 francs CFA (779 euro) versus 373,457 francs CFA (569 euro) for cerebral arterial infarction care. The following factors affected the total mean cost of stroke care: type of hospital (p < 0.0001), length of hospital stay (p = 0.001), type of stroke (p = 0.01), stroke severity (p = 0.001) and complications (p = 0.001). The level of contribution to stroke care expenditure covered by third parties was: 78% for patient families;2.8% for community self-help associations. Conclusion: In Congo, the mean in-hospital cost of stroke care is elevated considering the guaranteed minimum wage of 70,000 francs CFA (107 euro). Five factors affect the total mean cost of stroke care. Patient families are the main financial assistance system for stroke care expenditure. To minimize the heavy financial burden induced by stroke on patients, households and families, it is important to implement a health insurance system and strengthen the stroke prevention program.

Rising costs and hospital admissions for hepatocellular carcinoma in Portugal(1993-2005)

AIM:To determine,for hepatocellular carcinoma(HCC),the patient demographic profile and costs of their admissions to the hospitals of the Portuguese National Health System from 1993 to 2005.METHODS:The National Registry(ICD-9CM,Inter-national Classification of Diseases,155.0)provided data from the 97 Hospitals in Portugal.RESULTS:We studied 7932 admissions that progres-sively rose from 292 in 1993 to 834 in 2005,having a male predominance of 78%(6130/7932).The global rate of hospital admissions for HCC rose from 3.1/105 in 1993 to 8.3/105 in 2005.The average length of stay decreased from 17.5 ± 17.9 d in 1993 to 9.3 ± 10.4 d in 2005,P < 0.001.The average hospital mortality for HCC remained high over these years,22.3% in 1993 and 26.7% in 2005.Nationally,hospital costs(in Euros-€)rose in all variables studied:overall costs from €533 000 in 1993,to €4 629 000 in 2005,cost per day of stay from €105 in 1993,to €597 in 2005,average cost of each admission from €1828 in 1993,to €5550 in 2005.In 2005,1.8%(15/834)of hospital admissions for HCC were related to liver transplant,and responsible for a cost of about €1.5 million,corresponding to one third of the overall costs for HCC admissions in that same year.CONCLUSION:From 1993 to 2005 hospital admissions in Portugal for HCC tripled.Overall costs for these admissions increased 9 times,with all variables related to cost analysis rising accordingly.Liver transplant,indicated in a small group of patients,showed a disproportionate increase in costs.

Cost Accounting, Ethical Accountability, and Accounting Principles

This essay explains why cost accounting, ethical accountability, and accounting principles are interrelated concepts. During the past two decades, the relationship between accounting systems and discharge of accountability has increasingly drawn the attention of researchers. However, researchers have shown a marginal interest in the inclusion and examination of the theme of cost accounting, and in particular, no interest has been oriented to explore the potential role of cost accounting in serving presentation of the trustful cost information as regards the discharge of accountability. In this essay, we will reason that the traditional discourse of cost accounting is fundamentally different from the managerial discourse of cost accounting. The traditional cost accounting is built upon the ethical, legal, professional, and principle-based discourses. By exploring the differences between the two cost accounting discourses, this essay will reduce the effect of current skeptical views with which quality of our academic education, relevance of our research, and our understanding of the potential role of cost accounting in serving the provision and presentation of trustful information have been seriously undermined.

The development and change study of cost accounting in the IT environment

Relative to costs of computerized accounting, the cost accounting information further to get rid of the shackles of artificial accounting, reflecting a pure information management thinking, which contains a richer content, and traditional cost accounting theory a profound impact on the system. Clear understanding of the environment in the IT development process cost accounting will help us actively to promote cost accounting change, innovation and development.

Influencing factors of hospitalization costs for glaucoma patients under clinical pathway management

Background:To investigate and analyze the hospitalization costs of inpatients with primary acute angle closure glaucoma(PACG),and to explores the influencing factors of hospitalization cost and to provide reference for specialized hospitals to carry out clinical pathways.Methods:The first page diagnostic data of PACG patients’medical records were collected,and an Excel database was established according to the International Classification of Diseases(ICD-10)code.Statistical analysis of hospitalization data was performed using SPSS 17.0 software.Results:Hospitalization days and clinical pathway which affect the change of the hospitalization cost(P<0.001).Conclusions:Hospitalization day is an important factor affecting the hospitalization cost,reducing unnecessary hospitalization time can control the increase of hospitalization cost.

COMPARISON OF A SAMPLE OF GREEN HOSPITALS WITH NON-GREEN HOSPITALS WITH RESPECT TO OPERATING EXPENSES AND PATIENT REVENUE

Concerns regarding the environmental impacts of hospitals have made the healthcare sector one of the most prominent settings for the green building movement.Despite these environmental concerns,the number of studies that document the benefits of sustainable healthcare facilities is limited.In this study,the authors used the Medicare and Medicaid cost report data to compare the financial performance of 14 Leadership in Energy and Environmental Design(LEED)certified hospitals against the average performance of non-green facilities.In line with studies conducted in other settings,the authors found that there are low and high performers among green hospitals.For this study,green hospitals had higher facility operating expenses than an average non-green hospital and spent more on plant operations.While green hospitals included in this study generated more revenue,the incomes were not high enough to validate the high operating expenses.

Relationship between the Current Account Balance Ratio and Salary Ratio in Japanese Municipal Hospitals

Background: While public municipal hospitals in Japan are supported by public financing and are less likely to fail than private hospitals, more than half are in financial deficit. Hospitals running at a deficit may have poorer outcomes and less investment in maintenance of human or physical capital, as well as increased rates of patient adverse events. We sought to clarify the relationship between municipal hospital surpluses or deficits and salary expenditures. Methods: We extracted financial data for 253 general hospitals of 300 beds or more from financial statements for the 2013 fiscal year available in the Yearbook of Public Firms, Edition for Hospital. From these data, we calculated account balance ratios and compared the average value of the ratio of labor to the output (salary ratio) for each group using analysis of variance (ANOVA). Results: The salary ratios of hospitals in the surplus group were significantly lower than the salary ratios of hospitals in the deficit group (55.5% vs. 49.4%;p p = 0.342). In the surplus group, the average value of salary ratios was different among the three-bed count groups (mean salary ratio: 53.0% vs. 48.5% vs. 47.4%;ANOVA p = 0.012). In addition, there was a significant difference in mean value between the 300-bed group and ≥500 beds group (mean salary ratio: 53.0% vs. 47.4%;p = 0.002). Conclusion: This study suggests that maintaining a favorable salary ratio to the current account balance is a useful proxy of fiscal health, and interventions to improve the salary ratio may be effective in improving municipal hospital management. Furthermore, among well-managed municipal hospitals, larger hospital size may confer some advantage in purchasing power.

Improving Hospital Utilization and Outcomes: Health Economics at the Community Level

This study reviewed efforts to improve health care efficiency at the community level from the perspective of the financial impact on provider organizations. It focused on utilization and outcomes programs that address this objective in the metropolitan area of Syracuse, New York and their implications for health economics. The study demonstrated that a range of length of stay initiatives, including programs addressing length of stay reduction between hospitals and nursing homes produced a savings of $12,448,300 - $31,232,900 over a fifteen-year period. These efforts involved community wide costs of $3,128,125 - $4,144,025. The study also demonstrated that efforts to reduce inpatient hospital complications produced a savings of between $1,622,400 - $3,623,400 over a four-year period. These efforts involved community wide costs of $739,200. The study suggested that these savings were enhanced through community wide initiatives that enabled hospitals to save expenses associated with data development and program implementation.

Making Sense of Hospital Project MisPerformance: Over Budget, Late, Time and Time Again—Why? And What Can Be Done About It?

Hospital projects worldwide often experience misperformance,showing a tendency to exceed their estimated cost,miss their deadline,suffer quality problems,and yield benefit shortfalls.Considering this ubiquitous problem,this paper aims to make sense of this phenomenon by addressing the following research question:How can we make sense of hospital project misperformance,and what can be done to mitigate its occurrence?We use an illustrative case study approach and the analytical lens of sense-making to examine the misperformance of three mega-hospital projects.Our research reveals issues such as scope changes,an inability to adapt and respond to risk and uncertainty,ineffectual project management and governance,and optimism bias,which combine to impact project performance adversely.We suggest that the two prominent theoretical perspectives dominating the literature in this field fall short of adequately explaining hospital project misperformance.We provide suggestions for improving the procurement process of hospitals and submit there is a need to develop a robust and balanced theory of project misperformance.

Improving System Wide Hospital Efficiency at the Community Level

This study reviewed programs to improve the efficiency of hospital utilization in the metropolitan area of Syracuse, New York between 1998 and 2015. It involved indicators that were largely under the control of hospitals and their nursing and administrative staffs, such as inpatient stays and post admission complications, as well as programs where there was less provider control such as inpatient admissions and readmissions. Large reductions in inpatient lengths of stay were generated by the Syracuse hospitals, contributing to a decline in the average daily adult medicine and adult surgery census of 140 patients. Reductions in post admission complications contributed to these developments. The study suggested that efforts to reduce inpatient admissions in the Syracuse hospitals had limited results. The areas hospital admission rate was conservative, but approximately 2000 resident discharges per year above that of a neighboring community. The need for reduction of hospital admissions resulted from the absence of provider or payor efforts to develop alternative resources in the community. If the experience of the Syracuse hospitals is typical, improvement of the efficiency of community health systems will require creativity and resources from providers. Perhaps more importantly, health care payors will need to assume an active role in these efforts.

Reducing Hospital Lengths of Stay: A Five-Year Study

Hospital length of stay reduction is an important mechanism for improving the outcomes and efficiency of care. This study evaluated the impact of length of stay reduction in the hospitals of Syracuse, New York. Between 2015 and 2020, length of stay reduction saved 7106 inpatient days for adult medicine, and 10,605 patient days for adult surgery in the hospitals. At a conservative late stay rate of $600 per day, $4,263,600 was eliminated for adult medicine and $6,363,000 was eliminated for adult surgery between 2015 and 2020. The study data suggested that the numbers of days saved were the greatest for patients with Major and Extreme severity of illness. At the community level, length of stay reduction can support the efforts of health care providers to free inpatient capacity for patients with Coronavirus and other conditions. It can also generate the efficiency needed to reimburse the costs of care.