| 1. Background and SignificancesPublic hospitals, non-profit organizations, are social welfare institutions undertaking certain welfare functions. With the improvement of the socialist market economy, especially the reform of health system, the cost accounting and control of public hospitals are being paid more and more attention. The hospital accounting can calculate and reflect income,expenditure and profit, can benefit expense-saving and efficiency-improving. Under the new situation, although many hospitals make precise cost accounting on clinical departments which generate benefits directly, they don't pay much attention on cost control of medical assistance, administration and logistics departments. The current researchs pay little attention to the cost management of sterile supply department and lack a calculative method. Therefore, considering the development situation of domestic sterile supply departments, it's necessary to integrate the theory and method of cost estimating in sterile supplies departments especially the sterile packages, to control the cost and improve management level of sterile supply departments effectively.2. Study Objectives and ContentsBy investigating the sterile supply departments in a first Class of Second Level hospital in Shanghai, basing on the definition of main sterile packages and adopting principles and methods of cost estimation in economics, the research eatimates on the cost of main sterile packages, compares the cost with current price, to provide basis on decision making of cost control, offer reference for small and medium hospitals to save operating costs.3. Research Methods(1) Literature analysisThe specific application of this research is divided into two levels:First, the collection of related material and information of principles, thoughts and methods about cost estimation in economics guiding this research promote smoothly as principals and methods. Second, collect document literature related to medical service and sterile packages in sterile supply department from relevant journal articles, books, government documents and government websites, etc..(2) Organization InvestigateThis research investigates general conditions and costs in the hospital and the sterile supply department from Year 2006 to 2009 of a secondary level hospital (Hospital A) in Shanghai. It collects the current status of sterile supply department which includes the basic situation of the hospital, workload, workflow and various sterile packages.(3) Depth InterviewThe search do depth interview with 5 relevant medical staffs and experts who are familiar with job and workflow in sterile supply department in Hospital A. to know their definitions of main sterile packages, analysis of problem and workflow, suggestions on improvement and insights on possibility of sterile packages outsourcing.(4) Cost estimation thoughts and methodsCost estimation is the process of tracking and gathering relevant resources spending on one project. The elementary principal is that there must be no omission. It means that whatever expenses only if spent on this project should contribute to the costs which include direct and indirect costs. In accordance with the component of cost estimation in economics, there are 6 aspects:(1) labor service charge; (2) official expense; (3) business cost; (4) consumption of general healthcare materials and other materials; (5) low value consumption goods; (6) depreciation and maintenance of fixed assets.4. Main study results(1) Definition and analysis of main sterile packages in sterile supply departmentThe research defines 22 sterile packages as the main packages by investigating organization and interviewing experts deeply. It includes cardiac massage set, tracheotomy set, priority operation set, bone marrow puncture set and air extracting set. Each sterile package mainly includes two parts, apparatus and accessories. For example, the cardiac massage set includes 20 apparatus and 17 accessories.(2) The actual cost of main sterile packages in sterile supply departmentAccording to the actual cost in sterile supply department, the total cost in Year 2006 is 2,537,300 Yuan while 2,731,600 Yuan in Year 2009. The average total cost of 2006-2009 is 2,619,100 Yuan. According to the classification of cost estimation, the average labor cost occupies the majority which equals to 890,500 Yuan and 34% of the total cost. It was followed by material cost which takes up 23.48% of the total cost.(3) Cost of main sterile packages in sterile supplies departmentThis research estimates unit costs of 22 sterile packages. For example, the cardiac massage set costs 202.82 Yuan while the tracheotomy set 278.86 Yuan, the priority operation set 77.95 Yuan, the bone marrow puncture set 49.68 Yuan and the air extracting set 17.60 Yuan.(4) The comparison between cost and price of the sterile packages in sterile supply departmentThe current prices of 22 main sterile packages are far below their unit costs. Assuming promoting the prices of these packages, making up the difference with direct cost, the Hospital A can increase income by 1,271,100 Yuan according to the average usage from Year 2006 to 2009. Assuming taking the indirect cost apportionment under consideration, the income could come up to 1,747,000 Yuan.5. Exploration and innovation(1) Control the cost increase of sterile packages with pertinenceWith the growth of equipment usage, its depreciation and maintenance cost increases gradually. It results in the continuous growth of labor cost. Therefore, on one hand, it's necessary to control cost on key area; on the other hand, it needs to expand compensation channels and increase price to compensate the growing cost of sterile packages in sterile supply department.The costs of 22 sterile packages consist mainly of labor and material cost, about 30% each. By cost estimating, it clearly reflects the different cost composition between various sterile packages and provides reference for cost controlling and reasonable allocation of related service and outsourcing.(2) Set the price of sterile packages reasonablyThe current prices of 22 sterile packages in sterile supply department in Hospital A are far below the unit costs. The highest proportion only reaches to 56.83%. The current prices are also much lower even compared with the indirect costs.. The research helps to find out the gaps between cost and price in the hospital and provide basis for reasonable decision making of cost controlling and price setting in sterile supplies department.(3) Discuss the possibility for the outsourcing of sterile packagesThe supply of main sterile packages in supply department is the subsidiary business of the hospital. The non-core business in hospital can carry out outsourcing to save room, purchasing and maintaining cost, and labor cost. However, if the supply room are completely outsourcing, there also exists certain risks.Through the analysis, we can make the conclusion that it can save costs in supply department by establishing regional sterile supply center. But it needs more supervision and guidance on sterile quality. |
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