Rising prices for medical services. "peculiarities of pricing and setting prices for paid medical services." The object of calculating the price of a medical service is
Prices for medical services will, of course, rise. The reason is obvious - the bulk of consumables and medicines, as well as medical equipment, are imported. The greatest increase will occur in the field of dentistry, since the share of imported drugs is traditionally higher here.
But the price increase will be much less than the dynamics of the national currency exchange rate, since the bulk of expenses (salaries, rent) are not related to foreign exchange transactions.
At the same time, businesses will try to contain price increases as much as possible. Competition in almost all regions is extremely high, and now not only the quality, but also the cost of services will come to the fore for consumers. The price increase will be within the limits of general inflation in the economy.
Timur Nigmatullin
Analyst at the investment holding "Finam"
According to my estimates, the volume of the market for paid medical services in Russia in 2014 amounted to about 700 billion rubles, which is 15 percent more than last year. I expect similar growth rates in 2015, despite the negative economic environment. The key growth factors remain the aging of the population and the reduction of government spending on medicine. The driver of price growth will be services related to oncological, cardiovascular diseases and dentistry.
Stepan Firstov
General Director of the FMC Medical Clinic
Our prices will rise by 15-20 percent due to an increase in the cost of consumables, in particular imported metal structures integrated into the body (these are precisely those items that there is nothing to replace yet). The prices for diagnostics will also rise, because they are often outsourced to laboratories, and they have already raised the price by ten percent. As for major operations in traumatology and orthopedics, we will offer the patient (where possible) alternative options with Russian metal, warning about the risk.
But many positions will remain unchanged due to the fact that the number of domestic producers has increased over the past three years. For example, we purchased light, surgical linen, a digital X-ray machine, modern gurneys, operating and dressing tables, and electrocoagulation devices for our new division from a domestic manufacturer. Therefore, there will be no surprises here.
Beauty industry
Elena Volodina
Injection procedures will rise in price the most (their cost has already increased by 15-20 percent), since the drugs are bought abroad. The only exception should be plasma lifting, if you do not add meso-cocktails to the plasma. Some clinics will try to make money from clients and will increase prices even for those materials that they managed to purchase at old prices: against the backdrop of a general rise in prices for services, this will not arouse suspicion. On a positive note: the price of hardware procedures, including laser procedures, should not change. Firstly, they are already expensive (for example, fractional resurfacing of the entire face costs from 20 thousand rubles), and secondly, they do not require additional expensive drugs.
The number of beauty salon clients is unlikely to decrease: routine procedures (manicures, haircuts and coloring) will always be in demand. During a crisis, the “lipstick” effect works: women are wary of large expenses, but at the same time they are ready to spend money on pleasant little things that allow them not to lose face during a crisis.
Andrey Volkov
No Strategy
The last couple of beauty industry exhibitions have seen unprecedented demand for Asian cosmetics. I think that in the next two years we will see a 90% replacement of the usual Italian, French, Swiss and American professional brands. All participants are afraid to raise prices for services, but prices for raw materials have already increased, so they are changing suppliers. Now we can say that there was almost no correction, five percent for the market. A slight decline can only be expected in the budget haircuts and nail design segments.
Education
Andrey Volkov
head of the consulting company No Strategy
Tuition prices were rising even without a crisis. The more prestigious the university, the faster prices rose. For example, popular MBA programs become more expensive every year by 10-15 percent. There is a possibility that many parents will not be able to bear the financial burden, and their children will go to study at other institutes or other specialties. Or they won't go at all. But today, world education is in a tectonic shift. Even the oldest universities in the world are rushing to stake their claim in the field of distance learning and are launching online learning projects. In addition to all the other delights, these programs are several times cheaper, and I think it will take no more than three to five years until society begins to seriously recognize them along with the traditional format.
Olesya Gorkova
Director of the language training center at Synergy University
In the segment of additional education, not only will prices increase, but demand will also change. The increase in the cost of an hour of lessons with a native speaker is compensated by increased quality requirements. At the same time, interest in premium format products will decrease: individual training, language support, etc. Now we are seeing a trend of changing interests in the languages being studied: the demand for studying East Asian languages is increasing, that is, Chinese and Arabic languages are moving from the category of exotic languages to the category of applied languages of business communication, however, English is 90 percent of the market.
Fitness
Andrey Volkov
head of the consulting company No Strategy
The most competitive market is St. Petersburg. It is estimated at 1.3 million season tickets. For a city of five million! Fitness operators no longer have the ability to raise prices. What has already happened in St. Petersburg will spread throughout Russia. Payment in installments, additional services, flexible rates day/night/freeze. Otherwise, the business will not be saved. Based on the results of the last quarter of 2014, all operators noted a sharp drop in sales of personal training - a very alarming signal. Tomorrow they may begin to refuse subscriptions.
Of course, there are alternatives to fitness. These are small specialized studios for cross-fit, cycling, aerobics, yoga, mixed martial arts and many others. And all-season outdoor training: running, walking, Nordic walking. Seasonal: bicycle, roller skates. Again, individual coaching programs of various formats. This year will be profitable for the fitness consumer, if, of course, nominal incomes remain unchanged.
At the end of last year, the Moscow Compulsory Medical Insurance Fund decided to increase tariffs for 29 medical services provided under the compulsory medical insurance program in antenatal clinics.
Tariffs for services such as primary and repeated appointments with an obstetrician-gynecologist were increased (by an average of 18%), the cost of a cervical biopsy increased by 24% from 620.87 rubles. to 771.9 rubles, aspiration biopsy of the endometrium increased by 26% and began to cost 370.97 rubles. instead of 295.25 rubles.
In total, in 2015, more than 12 million services were provided at these tariffs, of which 4.7 million services were provided in antenatal clinics, for a total amount exceeding 1.25 billion rubles.
The basic compulsory medical insurance program also includes management of pregnancy, childbirth, the postpartum period, and, if necessary, hospitalization in a gynecological hospital or in the pregnancy pathology department of a maternity hospital. In 2014, the fund also indexed tariffs for obstetric care, for example, the tariff for normal childbirth was increased fourfold from 6 to 24 thousand rubles, and in 2015 to 40 thousand rubles.
“Thus, the state pays for the entire period of a woman’s pregnancy from the moment of registration until discharge from the maternity hospital. On average, pregnancy management costs the Moscow compulsory health insurance system approximately 65 thousand rubles,” explains Vladimir Zelensky, director of the Moscow State Compulsory Medical Insurance Fund.
The increase in tariffs for services provided in antenatal clinics in Moscow is due to the fact that today not every clinic has full-time gynecologists. When seeking gynecological care due to pregnancy or the presence of chronic diseases, a woman must receive a referral from her general practitioner to the clinic where there is an appropriate specialist or department. This referral is issued once for the entire period of treatment and observation. If a woman seeks gynecological help at one time, then she needs to receive a referral before each visit to a specialist in another medical organization.
A woman also has the right to independently choose the medical organization where she wants to be observed. Moreover, this can be done not only on a territorial basis. In this case, she must also take a referral from her clinic and write a corresponding application addressed to the chief physician of the clinic.
They do not have the right to refuse to issue a referral to the antenatal clinic or to register with the consultation itself, except in cases where all doctors at the consultation have a workload that significantly exceeds what they are entitled to by law. In this case, the patient must be informed and explained that the high workload on the doctor, as a rule, affects the quality of observation and treatment.
It is important that when seeking medical care following a doctor’s referral to another clinic or antenatal clinic, you do not have the right to be required to register, pay for prescribed tests or consumables.
For the provision of medical services not at the place of attachment, medical organizations make “horizontal” mutual settlements among themselves.
Representatives of the largest private clinics do not expect explosive growth in the commercial medicine segment until 2020; on average it will amount to 5–10% annually. These are the results of a survey conducted by Ernst&Young (EY). Private owners still see opportunities in the shortcomings of their main competitor - state medical institutions, namely, they count on a decrease in the availability of medical care under compulsory medical insurance, low quality and level of service in the public sector, realizing, however, that the audience of state hospitals will not be able to significantly influence the effective demand.
“The study of the commercial medicine market in Russia for 2016 – the first half of 2017” was conducted from April to July 2017, and more than 25 of the largest private multidisciplinary medical organizations from different regions of the country took part in it. When selecting respondents, EY employees were guided by the “TOP 100 private multidisciplinary clinics in Russia” of the Vademecum Analytical Center. About 75% of EY study participants are in the TOP50 ranking. The total revenue of the companies participating in the study in 2016 amounted to more than 55 billion rubles.
According to BusinesStat, in 2016, the total volume of the market for legal commercial medicine and the VHI sector in Russia amounted to 515 billion rubles, showing an increase of 8.4%. This was mainly influenced by an increase in the average cost of a medical appointment by 14%; in physical terms, the segment decreased by 5%.
In 2016, the revenue of EY respondents grew by 11.6%, the most among clinics in the “business segment” - at 12.5%, in the mass segment of the market the growth was at 7.6%, in the premium segment - 9.4% . But premium clinics recorded the highest operating profitability – at 37.3% – due to the high cost of services and the predominance of individuals in the structure of patient flow. For the same reason, including due to more active work on voluntary health insurance programs, the average operating profitability is almost two times lower in the business segment and 2.5 times lower in the mass market segment.
Representatives of premium clinics claim that their revenue growth was ensured by an increase in patient flow (by 4.6%), the business segment also saw an increase in the number of patients, but the main driver of growth was a significant increase in the cost of medical services - by 10.6%, which compensated for the drop in volumes medical care provided. Clinics in the mass segment also increased prices (by 11%), but the number of services in the check decreased by an average of 1.2%.
Despite the fact that almost half of those surveyed (48%) noticed a drop in effective demand, the number of patients in their clinics increased or there was a redistribution in the structure of the patient flow. For example, in the business segment, some VHI patients moved into the category of paying clients, as insurance programs were reduced or employers offered the insured to pay extra for some services on their own.
About half of EY respondents are conservative in their forecasts for market growth and estimate it at 5–10% per year. This will be the dynamics until 2020. Just over 20% of respondents believe that the market will grow more noticeably, that is, more than 10% per year, and 15% believe that we should not expect growth of more than 5% annually. The highest growth rates are expected in the hospital sector, as well as in the areas of laboratory medicine, pediatrics, rehabilitation and IVF. 28% of respondents started hospitals, 22% began to develop pediatrics, for example, they opened specialized departments and even entire clinics, 17% introduced telemedicine services and began providing IVF services, another 11% of respondents began to engage in cosmetology and other niche areas, such as rehabilitation, dentistry , spa treatment, ophthalmology, osteopathy, industrial medicine and so on.
The drivers of market growth, according to surveyed representatives of private clinics, will be standard until 2020 - a decrease in funding and a reduction in the number of public health facilities; reduction in the services provided under compulsory medical insurance, reduction in the availability of medical care; low level of medical care, including due to a reduction in the number of doctors and medical staff; problems with obtaining medical services at the time of treatment, low level of service, and so on. “At the same time, about 10% of clinics said that they did not expect a massive transition of compulsory medical insurance patients to the private sector due to low effective demand,” says the EY report.
At the same time, survey participants rightly noted that in the segment of paid services, competition with state clinics is growing. “The market for paid services will grow given the fact that government medical organizations are actively entering it. Every clinic or hospital has already entered the paid medicine market or is preparing to do so,” said one of the respondents. According to the Vademecum Analytical Center, participants in the TOP 100 regional state hospitals with the highest commercial income in 2016 totaled only 14.6 billion rubles from paid services. And although they received over 139.1 billion rubles from the compulsory medical insurance system and budgets of various levels, competition will still intensify - all in the same inpatient unit. Employees involved in the provision of inpatient medical care are in demand on the market, but are in no hurry to move from the public sector, since they have the opportunity to receive a salary increase for the provision of paid services. Interestingly, according to 19% of EY respondents, increased competition from public clinics will be one of the factors in the development of the commercial medicine market in the coming years.
Also, socio-demographic factors will contribute to market growth: increasing life expectancy and the aging of the population, demand for preventive medicine and quality medical services, as well as public health problems, including due to poor environmental conditions and lack of prevention. This is especially true for patients over 40 years of age, who form the backbone of effective demand - according to respondents, “checks for patients over 40 years of age are one and a half times larger than for those who are younger.”
A third of respondents hope for an improvement in macroeconomic conditions and an increase in real disposable income of the population. And some of the respondents (20%) count on changes in government policy. For example, an increase in the number of public-private partnership projects, state regulation in the field of compulsory medical insurance, voluntary health insurance, telemedicine, and so on, attracting more private players to the system of providing specialized and high-tech medical care. At present, however, as Vademecum has repeatedly written, there are problems both in telemedicine and in private clinics in providing expensive medical care under compulsory medical insurance and government orders.
The internal resources of the market players surveyed by EY are as follows: searching for new niches and expanding the range of medical services, developing high medical care in the private sector, increasing investments in the industry, and according to the Vademecum Analytical Center, in just eight months of 2017, the volume of declared investments in the largest medical projects exceeded record levels for the industry 78 billion rubles.
In pursuance of the Decree of the Moscow Government dated December 21, 2010 N 1076-PP “On the procedure for the exercise by executive authorities of the city of Moscow of the functions and powers of the founder of public institutions of the city of Moscow”, a joint order of the Department of Economic Policy and Development of the City of Moscow and the Department of Finance of the City of Moscow dated September 5, 2011 of the year N 123-PR/264 “On approval of the Methodological Recommendations for establishing the procedure for determining fees for the provision by state budgetary institutions of the city of Moscow to citizens and legal entities for a fee of public services (performance of work) related to their main activities” I order:
1. Approve the Procedure for determining fees for the provision by government institutions of all types of the Moscow Health Department to citizens and legal entities for a fee of state services (performance of work) related to their main activities, provided in excess of the established state assignment, as well as in cases determined by federal laws , within the established state assignment (hereinafter referred to as the Procedure) (appendix to this order).
2. Directors of state government institutions of the directorates for ensuring the activities of state health care institutions of administrative districts must ensure the preparation of documents for the approval of lists of paid services of state institutions of the Moscow Health Department (hereinafter referred to as state institutions) on a territorial basis.
3. Deputy Heads of the Department of Health Care of the City of Moscow Khripun A.I., Korsunsky A.A., Department of Organization of Medical Care (Pogonin A.V.) and Department of Organization of Medical Care for Children and Mothers (Proshin V.A.) of the Department of Health Care of the City of Moscow ensure the coordination of lists of paid services of government agencies in the city of Moscow.
4. When providing paid services, heads of government institutions of all types must be guided by the Procedure approved by this order and the current legislation of the Russian Federation.
5. This order comes into force from the date of signing.
6. Consider the order of the Moscow Department of Health of February 20, 2006 No. 86 “On approval of the price list of paid medical services provided by medical institutions of the Moscow Department of Health” as no longer in force.
7. Entrust control over the implementation of this order to the deputy head of the Moscow Department of Health, I.G. Tretyakov.
Application
to the order of the Department
Moscow health care
dated December 14, 2011 N 1743
Order
determination of fees for the provision by government agencies of the city of Moscow of all types of the Department of Health of the city of Moscow to citizens and legal entities of public services (performance of work) related to their main activities, provided in excess of the established state task, as well as in cases determined by federal laws, within the established government assignment
1. This Procedure was developed in accordance with the Methodological Recommendations approved by the order of the Department of Economic Policy and Development of the City of Moscow and the Department of Finance of the City of Moscow dated September 5, 2011 N 123-PR/264, in order to establish a unified mechanism for setting prices for the provision of public institutions of the city of Moscow (hereinafter referred to as the institution) to citizens and legal entities for payment of government services (performance of work) related to the main types of activities provided in excess of the established state task, as well as in cases determined by federal laws within the established state task (hereinafter referred to as paid services).
2. The institution independently, in accordance with the charter, current legislative and other regulatory acts of the federal, regional and departmental level, determines the possibility of providing paid services provided in excess of the established state assignment, depending on the material base, the number and qualifications of personnel, demand for the service (work ) and other conditions.
3. The institution creates and approves lists of paid services in agreement with the Moscow Department of Health.
In cases where federal laws provide for the provision of a service (work) by an institution for a fee within the limits of the state task, including for preferential categories of consumers, such service (work) is included in the departmental list of government services (work) for which the state task is formed.
4. Prices for paid services are formed by the institution in accordance with the formation methodology established by this Procedure and are approved by order of the head of the institution, except for the prices for paid services specified in clause 7 of this Procedure.
5. The formation of prices for paid medical services is carried out in accordance with the calculation methodology set out in subsection 1 of section I of this Procedure.
6. The formation of prices for paid educational and other non-medical services provided by subordinate government institutions is carried out using the calculation and analytical method set out in subsection 2 of section I of this Procedure.
7. Tariffs for orthopedic dental services provided to preferential categories of citizens at the expense of the budget of the city of Moscow, categories of citizens and the amount of benefits they receive are regulated in the manner established by the Moscow Government.
8. The price for a paid service is determined based on:
the amount of estimated and estimated and standard costs for the provision of paid services by the institution for the main types of activities, as well as the amount of estimated and estimated and standard costs for maintaining the institution’s property, taking into account:
analysis of the actual costs of the institution for the provision of paid services for the main types of activities in previous periods;
forecast information on the dynamics of price levels (tariffs), the cost of expenses included in the costs of providing paid services by an institution, including state-regulated prices (tariffs) for goods, works, services of natural monopolies;
analysis of the existing and projected volume of market offers for similar services and the level of prices (tariffs) for them:
Analysis of the existing and projected volume of demand for similar services.
9. The frequency of changes in prices for paid services is determined by the head of the institution, except for the prices specified in clause 10 of this Procedure.
10. Prices for paid educational services should be approved annually before July 1 of the current year by order of the head of the institution.
11. For certain paid services, the provision of which is of a one-time (non-standard) nature (including for the performance of research and development work related to the main activities of the institution), the price of the paid service can be determined on the basis of standard hours, standards time, one-time cost calculation agreed with the customer or based on market value.
12. The price of a paid service per unit of provision of a paid service cannot be lower than the amount of financial support for the same services per unit of provision of a public service performed within the framework of a state task.
13. An institution providing paid services is obliged to place in an accessible place for review the necessary and reliable information about the list of paid services provided and their cost.
14. The list of categories of citizens who are entitled to benefits for paid services and the amount of discounts on prices are formed by the institution, agreed upon with the Moscow Department of Health and approved by order of the head of the institution.
15. The procedure for determining fees for the provision of all types of paid services by government institutions, approved by the Moscow Department of Health, lists of paid services provided by health care facilities, the conditions for their provision and the amount of fees are subject to posting on the official website of the Moscow Department of Health.
16. An institution providing paid services is obliged to provide citizens and legal entities with the necessary and reliable information about the list of paid services provided and their cost in a timely manner and in an accessible place for review.
Section I. Methodology for determining the price for the provision of paid services by government institutions of all types of the Moscow City Health Department
General provisions for calculating the cost of services (work).
The price of a paid service is determined based on the calculation of economically justified costs of material and labor resources (hereinafter referred to as costs) and profit, which ensures the financing of other justified costs and taxes.
P - profit (rub.).
The costs of an institution for the provision of a paid service are divided into costs directly related to the provision of a paid service, and costs necessary to ensure the activities of the institution as a whole, but not used directly in the process of providing a paid service.
Costs directly related to the provision of paid services include:
Costs for remuneration of personnel directly involved in the process of providing a paid service (key personnel);
Costs for the acquisition of inventories that are completely consumed in the process of providing a paid service;
Depreciation of equipment used in the process of providing paid services;
Other costs associated with the provision of paid services.
The costs necessary to support the activities of the institution as a whole, but not used directly in the process of providing a paid service (hereinafter referred to as overhead costs), include:
Costs for remuneration of personnel of the institution not directly involved in the process of providing paid services (hereinafter referred to as administrative and managerial personnel);
General business expenses - costs for the acquisition of inventories, payment for communication services, transport services, utilities, as well as for maintenance and ongoing repairs of facilities (hereinafter referred to as general business costs);
Costs of paying taxes, duties and other obligatory payments;
Depreciation of buildings, structures and other fixed assets not directly related to the provision of paid services;
Other costs necessary to ensure the activities of institutions as a whole, but not used directly in the process of providing paid services.
Subsection 1. Costs for paid medical services are calculated using the direct billing method.
The costs of providing a paid service are determined by the formula:
* - costs of providing a paid service (RUB);
* - costs of remuneration of key personnel (rub.);
* - costs for the acquisition of material reserves that are completely consumed in the process of providing a paid service (rub.);
* - the amount of depreciation of equipment used in the provision of services by the board (rub.);
* - other costs associated with the provision of services for a fee (rub.);
* - overhead costs attributable to the cost of a paid service (rub.).
1.1. Labor costs for key personnel include labor costs and charges for payments for a pile of key personnel (average monthly salary at the end of the previous year) and are calculated as the sum of the products of the actual cost of a unit of working time (for example, man-day, man-hour) by the number of time units required to provide a paid service.
The calculation is made for each employee involved in the provision of the corresponding paid service, and is determined by the formula:
* - labor costs for key personnel (rub.);
* - time rate (including accruals for wage payments). It is defined as the quotient of dividing the average official salary per month (with accruals) by the monthly working time fund (RUB/hour);
Calculation of labor costs for key personnel is carried out in the form according to Table 1.
Table 1
Calculation of labor costs for key personnel
(name of paid service)
1.2. Costs for the acquisition of inventories that are completely consumed in the process of providing a paid service are calculated as the sum of the products of average prices for inventories and the volume of their consumption in the process of providing a paid service.
The calculation is made for each type of inventory and is determined by the formula:
* - costs of inventories completely consumed in the process of providing a paid service (rub.);
MH - material stock of a certain type (units);
P is the price of inventory (rubles per unit).
Calculation of costs for inventories that are completely consumed in the process of providing a paid service is carried out in the form according to Table 2.
table 2
Calculation of inventory costs
_______________________________________________________
(name of paid service)
1.3. The amount of depreciation of equipment used in the provision of a paid service (*) is determined based on the book value of the equipment, the annual depreciation rate and the operating time of the equipment in the process of providing a paid service.
Calculation of the amount of depreciation of equipment used in the provision of paid services is carried out in the form according to Table 3.
Table 3
Calculation of equipment depreciation amount
_______________________________________________________
(name of paid service)
| N p/p | Name of equipment | Book value of equipment (RUB) | Annual depreciation rate (%) | Annual equipment operating time (hours) | Operating time of equipment during the provision of paid services (hours) | Amount of accrued depreciation (rub.) column 7 = column 3 x column 4 x column 6 / column 5 |
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| 1. | ||||||
| 2. | ||||||
| Total | X | X | X | X | * |
1.4. Other costs associated with the provision of paid services (*).
1.5. Overhead costs attributable to the cost of a paid service are determined in proportion (in proportion) to labor costs and accruals for payments for wages of key personnel directly involved in the process of providing a paid service, according to the formula:
* - overhead costs attributable to the cost of a paid service (rub.);
* - costs of remuneration of key personnel directly involved in the process of providing paid services (rub.);
* - overhead cost coefficient is calculated using the formula:
* - actual costs for remuneration of administrative and managerial personnel (rub.);
* - actual general business expenses, duties and other obligatory payments (rub.);
* - the amount of depreciation of property for general economic purposes (rub.);
* - total wage fund of all key personnel (rub.).
Actual labor costs for administrative and managerial personnel include:
Labor costs and accruals for wages of administrative and managerial personnel;
Costs for advanced training of all basic and administrative personnel.
Actual general business expenses include:
Costs of material and information resources, costs of services in the field of information technology (including the acquisition of non-exclusive (user) rights to software);
Costs of utilities, communication services, transport, costs of banking services, other services consumed by the institution when providing paid services;
Costs for maintaining real estate and especially valuable movable property, including security costs (maintenance of video surveillance systems, panic buttons, building access control, etc.), fire safety costs (maintenance of equipment, fire alarm systems, etc. etc.), costs of current repairs by type of fixed assets, costs of maintaining the adjacent territory, costs of rent for the use of property (if rent is necessary to provide a paid service).
The amount of depreciation of general business property is determined based on the book value of the equipment and the annual depreciation rate.
Calculation of overhead costs is carried out in the form according to Table 4.
Table 4
Overhead calculation
_______________________________________________________
(name of paid service)
1.6. The price for a paid service is calculated using the form according to Table 5.
Table 5
Calculation of the price for a paid service
_______________________________________________________
(name of paid service)
| Name of cost items | Amount (rub.) | |
|---|---|---|
| 1. | Labor costs for key personnel (*) | |
| 2. | Costs for purchasing consumables (*) | |
| 3. | Equipment depreciation amount (*) | |
| 4. | Other costs associated with the provision of paid services (*) | |
| 5. | Overhead costs attributable to the cost of a paid service (*) | |
| 6. | Total costs (*) | line 6 = line 1 + line 2 + line 3 + line 4 + line 5 |
| 7. | Profit (P) | |
| 8. | Price for paid service (*) (excluding VAT) | line 8 = line 6 + line 7 |
| 9. | Price for a paid service (including VAT) (calculated if the service (work) is recognized as an object of taxation by value added tax) |
Subsection 2. Calculation of costs for paid educational and other non-medical services provided by subordinate government institutions is carried out using the calculation and analytical method.
When using the calculation and analytical method, the costs of providing a paid service are calculated on the basis of the actual costs of the institution in previous periods based on the calculation of the average cost of a time unit (man-day, man-hour) and the number of time units (man-days, man-hours), necessary to provide the service (work).
When using the calculation and analytical method, the following formula is used:
* - costs of providing a paid service (RUB);
* - the sum of all expenses of the institution for a period of time (rub.), except for payment of scholarships and meals for educational institutions;
* - working time fund of the main personnel of the institution for the same period of time (hour);
* - standard working time spent by key personnel to provide paid services (hour).
Calculation of the price for a paid service
* - costs of providing a paid service (RUB);
* - price of paid service (RUB);
P - profit.
Order of the Moscow Department of Health of December 14, 2011 N 1743 “On approval of the Procedure for determining fees for the provision by government institutions of all types of the Moscow Department of Health to citizens and legal entities for payment of public services (performance of work) related to their main activities, provided in excess of the established state task, as well as in cases determined by federal laws, within the established state task”
Document overview
Prices for paid services provided by public institutions of the Department of Health are determined on the basis of the amount of estimated and regulatory costs for their provision, analysis of actual costs in previous periods, forecast information on the dynamics of price levels (tariffs), the cost of expenses included in costs, analysis of market offers for similar services, as well as demand for them.
The frequency of changes in prices for paid services is determined by the head of the institution, with the exception of prices for paid educational services, which are approved annually before July 1. Institutions providing paid services post in an accessible place information about the list of paid services provided and their cost.
The methodology for determining the price for the provision of paid services has been approved.
The calculations made and the final indicators of the medical institution are submitted to the chief administrator for approval.
When determining the cost of medical services, you should be guided by the following regulatory documents:
Civil Code;
Tax Code;
Law of the Russian Federation dated 02/07/1992 No. 2300-1 “On the protection of consumer rights” (as amended on 12/21/2004);
Decree of the Government of the Russian Federation dated March 7, 1995 No. 239 “On measures to streamline state regulation of prices (tariffs)”;
Decree of the Government of the Russian Federation dated February 20, 2001 No. 132 “On approval of the List of medical services for diagnosis, prevention and treatment provided to the population, the sale of which, regardless of the form and source of payment, is not subject to value added tax”;
Instructions for calculating the cost of medical services (temporary), approved by the Ministry of Health No. 01-23/4-10 and the Russian Academy of Medical Sciences No. 01-02/41 dated November 10, 1999 (hereinafter referred to as the Instructions for calculating the cost of medical services);
Orders of the Ministry of Health and Social Development of Russia dated April 10, 2001 No. 113 “On the implementation of the Industry Classifier “Simple Medical Services” and dated July 16, 2001 No. 268 “On the implementation of the Industry Classifier “Complex and Complex Medical Services”.
Subjects, as a rule, develop their own regulations that establish the procedure for setting prices for paid services.
For example, the Ministry of Health and Social Development for the Moscow Region has developed Methodological Recommendations for setting prices for medical services provided by state and municipal healthcare institutions in the Moscow Region on a paid basis (hereinafter referred to as the Methodological Recommendations for setting prices), approved by Order No. 261 dated June 22, 2006.
The objects of calculating the price of a medical service are:
Simple medical services (OK PMU N 91500.09.0001-2001);
Complex and complex medical services (OK N 91500.09.0002-2001).
The basis for calculating the price of a medical service actual expenses, planned or normative (if there are standards established by law) expenses of medical institutions and their structural divisions are included.
To calculate the price of the service, accounting and statistical reporting data is required:
a) about all types of expenses of the institution as a whole;
b) about all types of costs of structural divisions;
d) about the working time fund of medical personnel;
e) on the number of patients treated in the institution as a whole and in specialized departments of the hospital;
f) planned and actual indicators on the number of patients treated by institution, by hospital departments and individual nosological forms of diseases.
Prices for medical services are not subject to state regulation in accordance with the Decree of the Government of the Russian Federation of 03/07/1995 No. 239 “On measures to streamline state regulation of prices (tariffs)”, therefore, the methodology for calculating costs and the level of profitability can be determined by the institution (organization) independently.
When developing a methodology for calculating the cost of one unit of paid medical service, you can be guided by the Methodological recommendations for pricing (provided that the territory of the subject or municipality in which the medical institution operates has not approved its own methodological recommendations for pricing).
Our position on the application of this document is based on the fact that the Methodological recommendations for pricing were developed taking into account the Instructions for calculating the cost of medical services.
In addition, the Methodological recommendations for pricing are dated 2006, in contrast to the Instructions for calculating the cost of medical services (approved by the Minister of Health in 1999), therefore they take into account all changes in legislation and modern market relationships between subjects and objects of the market structure.
Formation of the cost of a paid service based on Methodological recommendations for pricing.
C = Rs + Pr + N,
where Рс is the cost of the service;
Pr - profit;
N - taxes on the service (VAT, which is determined in accordance with the current legislation of the Russian Federation).
The cost of paid medical services is calculated using the formula:
Рс = Ррр + Рксв,
where Rpr - direct costs;
Rkosv - indirect costs.
Direct costs include costs technologically related to the provision of the service and consumed in the process of its provision:
Remuneration of key personnel;
Medicines, dressings, disposable medical supplies;
Depreciation of soft equipment by main divisions;
Depreciation of equipment used directly in the provision of medical services.
The guidelines detail the procedure for calculating each of these types of expenses.
Depreciation of equipment included in fixed assets per medical service is taken into account in proportion to the time of its provision.
To indirect costs in accordance with clause 3.1.6. Methodological recommendations for pricing include costs necessary to ensure the operation of the institution, but not consumed directly in the process of providing medical services:
Accruals for wages of general institutional personnel;
Household expenses (consumables and supplies, payment for communication services, utilities, maintenance, etc.);
Wear and tear of soft equipment in institutional departments serving the diagnostic and treatment process, but not directly involved in the provision of medical services;
Depreciation of buildings, structures and other fixed assets not directly related to the provision of medical services; - other expenses.
In the cost of the j-th medical service, indirect costs are included in proportion to direct costs through the calculated indirect cost coefficient:
Rkosvj = Rprj x Kkrj,
where Rkosvj is the amount of indirect costs included in the cost of a specific j-th medical service;
Rprj - the amount of direct costs included in the cost of the j-th medical service;
Ккрj - the coefficient of indirect costs included in the cost of medical services, calculated for the entire volume of medical services provided in accordance with the work plan for the next year or according to the data of the previous period.
The cost of a complex medical service is calculated by summing up the costs of simple medical services included in its composition (clause 3.2. Methodological recommendations for pricing).
For example, a clinical blood test consists of a number of simple medical services: hemoglobin determination, red blood cell count, leukocyte count, erythrocyte sedimentation rate count.
In this case, labor costs and reagent costs are calculated for each individual study and then summed up.
Here, the price of a medical service is determined based on the cost of one bed-day. Moreover, special attention is paid to calculating the cost of complex medical services provided in inpatient departments of healthcare institutions.
As already mentioned, when determining the cost of medical services, you can use the recommendations given in the Instructions for calculating the cost of medical services.
The estimated cost of the service will reflect the actual costs without taking into account the technology for performing the work. Calculation of the cost of services should be made in accordance with the technology used in the provision of this service; standards for types of costs, adjusted in accordance with the price change index or the ruble exchange rate in relation to freely convertible currency.
When calculating the costs of medicines, the amount of expenses for this department must be divided by the volume of standard units performed.
Then the costs for a specific type of service are determined as the product of labor costs and the cost of one conventional unit of medicines.
Due to the fact that prices for different medications differ, the costs for this expense item differ several times depending on the type of work performed and do not depend on their labor intensity. When calculating the costs of medicines, you need to take into account the labor intensity of the service provided. Indirect costs according to the general coefficient are distributed in proportion to direct costs.
As a result of the distribution of indirect costs in proportion to direct costs, their significant deviation from the actual costs of utilities, household items, and repairs is allowed.
Indirect costs for utilities, household items, and repairs should be distributed taking into account the share of paid services in the total volume of services provided.
If a medical institution independently develops a methodology for calculating the cost of medical services, it must provide for:
Costs to be calculated;
Units of calculation (bed-day, visit, diagnostic examination, etc.);
The procedure for distributing indirect costs (it is developed with the aim of forming the cost of a paid medical service and may differ from the procedure used for tax purposes).
It should be kept in mind that:
The service is provided in accordance with a quality standard that provides for full compliance with the technology of the treatment process and full reimbursement of material costs;
To calculate direct costs, natural standards can be used;
In the absence of natural standards, the institution calculates the amount of expenses taking into account their economic feasibility and conditionality of business practices.
When determining the cost of a paid medical service, the question arises: should one take into account when calculating the amount of accrued depreciation on fixed assets acquired from budgetary funds or compulsory medical insurance funds and used to provide paid services.
The list of costing items is determined by the types of costs associated with the implementation of a specific type of activity. Since equipment purchased at the expense of the budget or compulsory health insurance funds is used to provide paid services, depreciation of the equipment must be included in the cost of the service. Modern requirements for accounting (budgetary) accounting assume that depreciation is charged on equipment purchased by a budgetary institution, therefore the inclusion of depreciation in the price of a paid service from this point of view is beyond doubt.
Often, medical institutions are prohibited by the main managers and tax authorities from including depreciation of equipment in the calculation (costs) on the basis that the institution does not (did not bear) the costs of its acquisition in connection with the implementation of business activities.
Such arguments are not convincing.
Because if depreciation is not included in the cost of the service and is not reimbursed through the price, then the “budget” equipment will be unlawfully used to provide paid services, that is, there will be misuse of budget funds or compulsory medical insurance funds. As a result, state (municipal) property will be used to provide paid services free of charge. In this case, the market for paid services is destabilized.
Based on the economic meaning of the transactions performed, we can conclude that depreciation accrued on fixed assets (equipment) used in the provision of paid services and purchased at the expense of the budget or compulsory medical insurance must be included in the cost of the paid service and subsequently (when paying services provided) return to the budget.
However, since today there is no mechanism for reimbursement of accrued depreciation to the budget when providing paid services, this procedure can only be carried out within the framework of so-called management accounting, which reflects the essence of economic processes and is not burdened with formal requirements.
The cost of equipment purchased at the expense of the budget or compulsory medical insurance funds and used for business activities can only be reimbursed by using part of the profit received from the provision of paid services, equivalent to the amount of depreciation of “budget” equipment and equipment purchased at the expense of compulsory medical insurance funds, to support budgetary activities.
To indicate the cost of consumed by a medical institution There are several different terms used for resources: costs, costs, expenses, cost. In most cases they are used as synonyms. However, each of these terms also has a specific meaning. Meanwhile, in many cases, these terms (with the exception of “cost”) can also reflect the amount of resource consumption in physical or labor terms (electricity consumption, electricity costs; labor costs, etc.).
Thus, some authors believe that expenses are part of the costs of manufacturing products and providing services sold in a given accounting period. The moment of transition of costs to the state of expenses is determined by the moment of shipment of products. Others, on the contrary, believe that, unlike expenses, expenses are strictly tied to the reporting period. There is a point of view that the concept of “costs” is broader than the concept of “cost”, which represents the costs of simple reproduction, the current expenses of a particular manufacturer.”
A medical service, like any product, has a value, a monetary value, which is the price. Prices for services consist of two main elements: cost and profit.
To calculate prices for medical services, the concept of “profitability” is also used, which is generally determined by the ratio of profit to cost (there are other indicators of profitability).
“To calculate the cost of medical services, the structural divisions of a medical institution are divided into main and auxiliary.
The main divisions of a medical institution include: specialized departments of hospitals, departments (offices) of clinics, diagnostic centers, outpatient (treatment and diagnostic) departments and offices in which the patient is provided with medical services.
Supporting units include institutional services that support the activities of clinical and treatment and diagnostic units (administration, personnel department, accounting, medical statistics office, registry, pharmacy, sterilization, housekeeping services, etc.).
Meanwhile, another grouping is used - with an additional allocation of service units. In this case, auxiliary units include units that help provide medical care: pharmacy, sterilization room, etc., and service units include units that ensure the functioning of the institution: administration, personnel department, accounting, business services, etc.”
The following classification of costs for the provision of medical services, grouped according to various criteria, can be given.
By departments involved in the provision of services:
Costs of the main medical (clinical) department;
Costs of paraclinical (therapeutic and diagnostic) services - laboratory, radiology department, etc.;
Anesthesia service costs;
Costs of the operating unit (wages of nurses and attendants of the operating unit, consumables, etc.);
Consultations with specialists from other services (ENT, ophthalmologist, etc.);
Costs of auxiliary (service) departments - sterilization, procedural, etc.;
Housekeeping costs;
Costs of administrative and management personnel (AUP).
The structure of tariffs for medical services usually consists of the indicated main blocks, some of which, depending on the adopted methodology, the specifics of the service, and the payment procedure, may be excluded or replaced by others.
For participation in the provision of services (in relation to the process of providing services), expenses (expenses) are divided into:
Basic;
Invoices.
Basic - expenses directly related to the provision of services - wages, medicines, medical instruments, etc. It should be noted that the costs of heating, electricity, water supply are also among the main expenses.
Institutional overhead costs include all types of expenses not directly related to the provision of medical services (clerical and business expenses, depreciation of non-medical equipment, salaries of administrative and management personnel, business travel expenses, etc.).
In other words, overhead costs are those types of costs that are necessary to ensure the activities of the institution, but are not consumed directly in the process of providing medical services.
Note that the assignment of specific types of expenses is always conditional.
According to the order of attribution to services (by the method of inclusion in the cost; by the method of attribution to the cost), costs are divided into:
Indirect.
Direct expenses are expenses that can be directly (immediately), without any auxiliary calculations, attributed to certain types of medical services provided. In other words, direct costs are associated with the production of specific specific types of services.
Direct costs include:
Salaries of key personnel;
Accruals for wages of key personnel;
The cost of all material resources consumed in the process of providing medical services (medicines, dressings, disposable supplies, food, etc.);
The cost of partially consumed material resources (wear and tear of soft equipment, depreciation of medical equipment used in the provision of this medical service, wear and tear of low-value and fast-wearing items).
Indirect - costs that cannot be directly attributed to specific types of services and therefore distributed indirectly, as a rule, in proportion to some indicators (established bases). Indirect costs are included in the cost of medical services through calculated coefficients. Indirect costs are associated with the production of several types of services or all services provided. Therefore, indirect costs usually relate to the entire institution or its divisions.
To indirect costs include, for example:
Remuneration of general institutional personnel;
Accruals for wages of general institutional (administrative and economic) personnel;
Utility and business expenses (costs of materials and items for current business purposes, office supplies, inventory and payment for services, including costs of current repairs, etc.);
Expenses for business trips and official travel;
Wear and tear of soft equipment in auxiliary departments;
Depreciation (wear and tear) of buildings, structures and other fixed assets not directly related to the provision of medical services;
Other expenses.
The basis for the distribution of indirect costs may be direct costs, wages of key personnel, space, etc. Thus, part of the indirect costs is distributed in proportion to the wages of key personnel (for example, the salary of administrative and business personnel). Others (for example, utility costs) can be distributed in proportion to the area, etc.
In some cases, indirect costs can become direct if, for example, electricity meters are installed in each office.
It should be noted that the main costs can be both direct and indirect, and overhead, as a rule, are indirect costs. For example, the costs of electricity and water supply are among the main costs, and at the same time they are indirect costs, attributed to the cost of the service using indirect methods. It is necessary to note the features of the classification of costs of diagnostic and treatment services. Costs directly related to the implementation of research and the provision of medical care are considered the main expenses. Most of these types of expenses can be classified as direct. However, if the cost of a bed-day, a completed case of treatment (inpatient or outpatient), etc. includes the costs of treatment and diagnostic services in an average amount, they will be distributed among the main clinical departments using auxiliary methods, i.e. will be classified as indirect costs.
As part of overhead and indirect costs, hospital-wide (general outpatient) and institutional costs can be distinguished.
According to the degree of dependence on the volume of services provided (in relation to production volume; according to cost dynamics), costs are divided into:
Conditionally permanent (permanent);
Conditional variables (variables).
Conditionally permanent (constant) - costs that are practically independent of the volume of services provided (room lighting, heating, etc.). The amount of fixed costs remains unchanged when the volume of production changes (time-based wages of workers, wages and charges for wages of the administrative and economic apparatus, rental of premises, etc.).
Conditional variables (variables)- costs that vary according to the volume of services provided (medicines, consumables, food, etc.). In other words, the total amount of variable costs changes in proportion to the volume of production.
The grouping of costs by costing items reflects their composition depending on the direction of costs for the provision of services in accordance with the economic classification.
Costs attributable to cost, in accordance with the current accounting (budget) accounting system in budgetary organizations, include costs for all costing items aimed at providing medical services.
Classification by economic elements is based on the grouping of all costs that are homogeneous in economic content, regardless of the place where they are incurred (polyclinic, hospital, diagnostic unit, administrative departments, etc.), as well as on the object of the cost (outpatient patient, research blood, etc.).
When determining the cost of any type of medical services, the following grouping of costs by economic elements is used:
Labor costs;
Payroll accruals;
Direct material costs (medicines, food, etc.);
Overheads.
Labor costs refer to the costs of remunerating healthcare workers providing services.
Payroll accruals provide for the costs of paying contributions to state extra-budgetary funds.
Marginal cost- these are the costs that will be required to produce one additional unit of goods or products in relation to the estimated or actual production volume. In other words, it is the incremental cost required to obtain the next unit of the product. To find marginal costs, it is necessary to subtract the indicators of two adjacent gross costs. Thus, in its form, marginal cost is very similar to the marginal utility of a good. Marginal physical product is the increase in output in physical units produced by an additional unit of variable costs when other costs do not change. For example, by maintaining the level of costs for raw materials and energy, but increasing labor costs, you can thereby increase production by one additional unit. However, economic calculations have a monetary form. Thus, the concept of marginal cost is preferable because it is expressed in monetary units, as opposed to a physical product, which is measured in physical units (meters, pieces, etc.).
What other advantages does marginal analysis provide in the economic study of costs or expenses? The decision-making process is primarily about comparing costs. As a result, it may often be advisable, for example, to replace expensive resources or raw materials with cheaper analogues. Such comparisons are best made using limit analysis. Marginal costs should be distinguished from terms such as “sunk costs,” which describe lost opportunities associated with a previously ill-considered decision. For example, you purchased shoes, but for some reason they didn’t suit you. You are forced to sell them at a price lower than the original cost. The difference between the purchase price and the selling price represents sunk costs. The latter represent losses and are not taken into account in the decision-making process.-
It is also necessary to distinguish between average and marginal costs.. Average costs determined by dividing total costs by production volume. Obviously, the company cannot sell goods at prices below average costs, because then it will simply go bankrupt. Thus, average costs- an important indicator of the enterprise's performance. Average and marginal costs of production are interrelated. When the value of the first reaches the minimum, they must be equal to the second. It is for this reason that any economic decisions must be accompanied by marginal, or limiting, analysis. The inefficiency and effectiveness of alternative solutions can be assessed on the basis of limit comparisons, which involve assessing increments in the limit, that is, on the boundary of changes in specific quantities. The nature of economic decisions mainly determines what marginal costs will be and whether cost increments will be negative or positive.
As already noted, marginal cost is in many ways similar in form to marginal utility, where the additional utility of a good is implied. Therefore, all marginal values can be assessed as differential concepts, because in this case we are talking about an increase in additional values (costs, utility, and so on). Thus, marginal costs enable a firm to predict the competitive supply of its product. To do this, compare the marginal cost curve and the supply curve. Maximum profit will be achieved at the point where the supply curve and the equilibrium market price line intersect.
A firm's costs are the monetary expression of the costs of the factors of production needed to produce goods and services. In domestic practice, these costs are usually called prime costs.
For most manufacturing firms, the main cost items are the cost of raw materials, labor, depreciation, transportation, fuel and energy, etc.
Cost theory aims to help a company evaluate the efficiency of using resources in the present and minimize them in the future.
Marxist teaching considers a company's production costs as part of the cost of the goods produced, which compensates for the price of the means of production consumed and the price of the labor force used. According to this doctrine, the costs of an enterprise represent the embodied and paid living labor of workers and appear in the form of production costs. Proponents of this doctrine focus on the study of disparate factors influencing the value of cost. As a result of their research, they were able to provide specific recommendations for measuring costs and reducing them.
Modern Western cost theory is based on the scarcity of resources and the possibility of their alternative use.
This concept is based on the fact that the use of resources for one purpose means that they cannot be used for others. Any company at the planning stage of economic activity often has to choose between two or more possibilities. By giving preference to one of the economic methods of production, the company incurs not only the costs associated with its implementation, but also certain losses caused by lost income from not using an alternative opportunity. The firm's costs for implementing the chosen production method, added to the costs of lost opportunities, are defined as economic costs.
Depending on whether the firm pays for resources, economic costs can be divided into external and internal. External costs are the monetary costs of paying for resources owned by other firms. These are payments to suppliers for resources (raw materials, fuel, transport services, energy, labor services, etc.). Since these costs are reflected in the balance sheet and report of the company, they are usually called accounting costs. Internal costs are the unpaid costs of a firm associated with the use of resources that belong to it. These costs are equal to the cash payments that the firm could receive for its own resources if it chose the best option to provide them. Internal costs are often referred to as implicit, hidden, or opportunity costs.
Let's look at internal costs using the example of a small bakery store, the owner of which himself stands behind the counter. The owner of such a store does not pay himself wages for his work.
If, in addition, he uses the premises belonging to him, then he also incurs costs; associated with the lost opportunity to rent out this premises and receive rent. Using his own money to purchase bakery products, the owner loses interest on his money capital. The store owner could also use his entrepreneurial abilities in another field of activity. In order for the owner of this store to be able to hold on to the counter for a long time, he must receive a normal profit. Normal profit is the minimum payment that the owner of a company must receive in order for it to make sense for him to use his entrepreneurial talent in a given field of activity. Lost income from the use of own resources and normal profit in total form internal costs. Economic costs are calculated for the internal needs of the company and are used by it in the production management system. They differ from accounting costs by the amount of opportunity cost.
The difference between economic and accounting costs can be shown using a diagram:
The firm makes decisions about the use of resources based on economic costs, while ignoring sunk costs. This includes spending on factors that have no alternative use. An example of a sunk cost is specialized equipment that cannot be sold to another company if the business closes.
Depending on how production volume affects costs in the short term, a distinction is made between fixed and variable costs.
Fixed costs are costs whose value is not directly dependent on production volume. These include deductions for depreciation of buildings and structures, insurance premiums, salaries of senior management personnel, rent, etc. Fixed costs must be paid even if the firm produces nothing.
Variable costs include costs, the value of which varies depending on changes in production volume. These are the costs of raw materials, fuel, energy, most of the labor resources, and transport services. The company's administration can control the value of variable costs, since they can be changed in the short term by changing production volume.
In the long run, all costs should be considered as variable, since all costs can change over a long period, including costs associated with large capital investments.
There are total, average and marginal costs of production.
Total costs are the sum of fixed and variable costs for any given volume of production. They are determined by the following formula: TC = FC + VC, where TC, FC, VC are total, fixed and variable costs, respectively.
Average costs is the cost per unit of output. They can be determined by the formula AC - TC/Q, where AC - average costs; Q is the output volume.
In turn, average costs are divided into average constant AFC and average variable AVC. Average fixed and variable costs are determined by dividing the corresponding costs by the volume of output.
Average costs are used to decide whether to produce a given product at all. To determine whether to increase or decrease output, a firm uses marginal cost.
Marginal cost are the costs associated with producing an additional unit of output. They show the change in total production costs as production volume increases by one unit of output. Marginal cost MC is determined by the following formula:
Adequate representation of the head of the medical institution information about the state of the resources at its disposal and the effectiveness of financial and economic results gives it undeniable advantages over other health care facilities. In such a situation, it is possible, by planning in advance the effect of making certain decisions, to manage the economic situation in the institution.
Unfortunately, at present, the vast majority of health care facilities are guided by economic principles, norms and instructions that came from Soviet times. And while this may be sufficient for accounting and analysis of budget flows, extra-budgetary activities require a more “advanced” analysis, characteristic of any commercial enterprise.
The situation is further complicated by the fact that the method of economic analysis of economic activity, successfully used for industrial enterprises, cannot be applied to social institutions in a formulaic manner, without taking into account the distinctive characteristics of healthcare as a sector of the national economy.
Really, Features of economic analysis (economic assessment) of the economic activities of health care facilities and its divisions are determined by the specifics of medical activities :
· intangible production takes place (here the process of production and consumption of services coincides in time and space, it is difficult for society to keep track of the contribution of healthcare to the growth of the country’s national wealth);
· the subject of labor is a person (health care costs often exceed the financial capabilities of the patient);
· a medical service acts as living labor, which makes it difficult to determine its price, and, consequently, the income of healthcare facilities in market conditions;
· the object of appropriation is the specific labor activity of medical personnel, which is sometimes paid not according to the laws of the market.
Besides, any healthcare institution as a system is characterized : heterogeneity of constituent elements, diversity of economic ties, structural diversity and multiplicity of criteria for assessing the material and technical base, personnel, financing, etc.
It is necessary to take into account a large number of external and internal factors affecting individual indicators that ultimately determine the economic efficiency of a medical institution (Figure 1).
Economic analysis of the activities of medical institutions is carried out in the following areas:
Use of fixed assets;
Efficient use of bed capacity and medical equipment;
Assessment of income by sources of financing (budget financing, entrepreneurial activity, compulsory medical insurance financing);
Assessment of financial costs and costs of various types of medical care;
Effective use of medical and other personnel.
Along with this, the main economic indicators are calculated: total economic damage due to morbidity, disability and mortality, prevented economic damage and a criterion for the economic efficiency of medical care.
Analysis of the economic activities of individual departments and services of health care facilities, as economic units, is carried out in the same areas, but taking into account their specifics.
In conclusion, we note that economic analysis of the activities of a medical institution or its individual services is used to determine economic efficiency when comparing costs and economic effects. But when interpreting the results of the analysis, it is necessary to remember that in addition to economic efficiency, there is medical and social efficiency.
Economic efficiency in healthcare cannot be the determining criterion; the main thing is the medical and social effectiveness of health measures. Often, medical efficiency is dominant, requiring significant costs, the return of which may take place in the distant future or is completely excluded.
As a result of the analysis of the economic activities of health care facilities, recommendations should be obtained on the organization’s development strategy, based on the results of medical care and economic activities.
Assessment of the effectiveness of health care facilities - an integral part of a comprehensive planning system for a medical institution. Assessments of various aspects of efficiency should form the basis for the implementation of management decisions, aimed, among other things, at the successful organization of personnel work.
Since the activities of any medical institution are focused on ensuring the quality of medical care (QMC) and are considered as optimal care in accordance with the medical needs and demand of the patient, the efficiency of the medical institution (medical efficiency) can be considered synonymous with the quality of medical care.
Quality of medical care assessment (QM)- this is a procedure for unambiguously determining the acceptability or unacceptability, sufficiency or insufficiency of medical care. Evaluation of the IMC is, first of all, an assessment of patient satisfaction in a medical service. Evaluation of the IMC is an incentive, a means of motivating medical personnel. The assessment of IMC is the degree of economic efficiency of medical care.
Assessment of the effectiveness of the quality of medical care should be based on an analysis of indicators characterizing medical efficiency, social satisfaction of patients and costs incurred. Let us reveal the content of the listed indicators.
Medical efficiency coefficient(To med.) corresponds to the proportion of cases of medical care during which the planned result was achieved. The target value of this coefficient is equal to one.
Social efficiency coefficient(Social) characterizes patients' satisfaction with the medical care provided to them.
Ways to assess social satisfaction:
· informal discussion with patients and residents of health care issues;
· periodic surveys of patients immediately after they receive medical care (upon discharge from the hospital);
· ongoing research among patients and residents under special programs and using special questionnaires.
Cost Ratio(To costs) depends on the ratio of standard and actual costs for treating patients in a particular department. It is determined by the qualifications of the doctor and his desire to rationally use available resources.
The values of the three coefficients presented above make it possible to calculate the integral coefficient of effectiveness of medical care (K int.), which allows us to obtain a generalized assessment of the phenomena being studied.
Success rate(Cross.) is calculated as the ratio of the number of patients whose treatment achieved the planned result to the total number of patients treated.
Integral coefficient of medical care(K int.) is defined as the product of the performance coefficient (K res.), social satisfaction (K social) and the cost ratio coefficient (K costs):
K int. = K res. × To social × To expenses
In addition, by calculating the activity volume coefficient (Kvol.) and the efficiency coefficient (Keq.) by department, you can find efficiency ratio of the entire medical institution (To eff. d.):
To ef. d. = K vol. × K eq., where:
· medical care volume ratio (To volume) is found as the ratio of the actual number of treated patients to the planned number of patients;
· efficiency factor (To eq.) is the ratio of actually incurred expenses of departments to planned ones.
The activities of healthcare facilities are assessed as effective at the value of Keff. d. more than 1.0 and as ineffective - at a value of K eff. d. less than 1.0.
So, assessing the effectiveness of medical activities is the process of determining the real state of the medical care system provided in a medical institution in relation to the desired results.
Based on an objective assessment of the activities of a medical institution, management plans to improve the organization of personnel work in combination with economic planning. Only this approach can lead to the successful operation of health care facilities in modern conditions.
Labor productivity- the most important economic indicator characterizing the efficiency of labor costs in material production of both an individual employee and the enterprise team as a whole. Living labor is involved in the production of any product, i.e. labor spent by workers directly in the process of producing a product, and past labor spent by other workers and embodied in tools, buildings, structures, raw materials, materials, fuel, energy. Accordingly, a distinction is made between the productivity of individual (living) and social labor.
The main indicators of labor productivity at enterprises are output and labor intensity indicators. Output (B) is determined by the ratio of the quantity of products produced (Q) to the expenditure of working time on the production of these products (T), i.e. according to the following formula: B = Q/T Labor intensity is the reciprocal of output. There are standard, actual and planned labor intensity. Output (B) is determined by the ratio of the quantity of products produced (Q) to the expenditure of working time on the production of these products (T), i.e. according to the following formula: B = Q/T Labor intensity is the reciprocal of output.
There are standard, actual and planned labor intensity. Product output is the most common and universal indicator of labor productivity. Depending on the unit of measurement of production volume, there are three methods for measuring labor productivity: natural, labor and cost. The natural method of measuring labor productivity characterizes the production of products in kind per unit of working time. Natural indicators of labor productivity are expressed in kilograms, meters, pieces, etc. If an enterprise produces several types of homogeneous products, then output is calculated in conventionally natural units.
Natural indicators are used in enterprises of the oil, gas, coal, forestry and other industries, and conditionally natural indicators are used in enterprises of the textile, cement, and metallurgical industries. The labor method of measuring labor productivity characterizes the ratio of standard costs to actual working hours. The labor method is used to determine the efficiency of the use of workers' labor in comparison with standards, the level of fulfillment of production standards, or the degree of reduction in standard time by workers as a percentage. The cost method of measuring labor productivity has become more widely used, especially in enterprises producing heterogeneous products, as it makes it possible to take into account and compare various types of work by bringing them to a single meter.
Output can be determined per one worked man-hour (hourly output), one worked man-day (daily output), per average employee (worker) per year > quarter or month (annual, quarterly or monthly output). The most important task of the enterprise is the constant search and implementation of reserves for increasing labor productivity, which means existing, not yet used real opportunities to increase labor productivity.
Reserves for growth of labor productivity at an enterprise can be classified as follows:
Increasing the technical level of production as a result of mechanization and automation of production; introduction of new types of equipment and technological processes; improving the design properties of products; improving the quality of raw materials and using new structural materials;
Improving management, organization of production and labor by raising labor standards and expanding service areas; reducing the number of workers who do not comply with standards; simplification of the management structure; mechanization of accounting and computing work; increasing the level of production specialization;
Structural changes in production due to changes in the shares of certain types of products; labor intensity of the production program; shares of purchased semi-finished products and components; share of new products.