UNASSIGNED: The National Health Commission and the other relevant departments in China have initiated testing of the Diagnosis Related Groups (DRGs) system in 30 pilot locations since 2019. In the process of DRG payment reform, accounting for the costs of diseases has become a highly challenging issue. The traditional method of disease accounting method overlooks the compensation for the knowledge capital value of medical personnel.
UNASSIGNED: The primary objective of this study is to analyze the cost accounting scheme of China\'s Diagnosis Related Groups (C-DRG), focusing on the value of knowledge capital.
UNASSIGNED: The study initially proposes a measurement index system for the value of knowledge-based capital, including the difficulty of disease treatment, labor intensity of disease treatment, risk of disease treatment, and operation/treatment time for diseases. The Analytic Hierarchy Process (AHP) is then utilized to weigh the features of medical workers\' knowledge capital value. First, pairwise comparisons are conducted in this stage to develop a two-pair judgment matrix of the primary indicators. Second, the eigenvectors corresponding to the maximum eigenvalues of the matrix are calculated to generate the weight coefficient of each feature. The consistency test is carried out after this stage. An empirical analysis is conducted by collecting data, including the full costs of treating three types of diseases-hip replacement, acute simple appendicitis, and heart bypass surgery-from one public medical institution.
UNASSIGNED: The empirical analysis examines whether this DRG costing accounting can address the issue of neglecting the value of medical workers\' knowledge capital. The methods reconfigure the positive incentive mechanism, stimulate the endogenous motivation of the medical service system, foster independent changes in medical behavior, and achieve the goals of reasonable cost control.
UNASSIGNED: In the cost accounting system of C-DRG, the value of medical workers\' knowledge capital is acknowledged. This acknowledgment not only boosts the enthusiasm and creativity of medical workers in optimizing and standardizing the diagnosis and treatment process but also improves the transparency and authenticity of DRG pricing. This is particularly evident in the optimization and standardization of the diagnosis and treatment processes within medical institutions and in monitoring inadequate medical practices within these institutions.

Setting reimbursement rates in national insurance schemes requires robust cost data. Collecting provider-generated cost accounting information is a potential mechanism for improving the cost evidence. To inform strategies for obtaining cost data to set reimbursement rates, this analysis aims to describe the role of cost accounting in public and private health sectors in India and describe the importance, perceived barriers and facilitators to improving cost accounting systems. In-depth interviews were conducted with 11 key informants. The interview tool guide was informed by a review of published and grey literature and government websites. The interviews were recorded as both audio and video and transcribed. A thematic coding framework was developed for the analysis. Multiple discussions were held to add, delete, classify or merge the themes. The themes identified were as follows: the status of cost accounting in the Indian hospital sector, legal and regulatory requirements for cost reporting, challenges to implementing cost accounting and recommendations for improving cost reporting by health care providers. The findings indicate that the sector lacks maturity in cost accounting due to a lack of understanding of its benefits, limited capacity and weak enforcement of cost reporting regulations. Providers recognize the value of cost analysis for investment decisions but have mixed opinions on the willingness to gather and report cost information, citing resource constraints and a lack of trust in payers. Additionally, heterogeneity among providers will require tailored approaches in developing cost accounting reporting frameworks and regulations. Health care cost accounting systems in India are rudimentary with a few exceptions, raising questions about how to source these data sustainably. Strengthening cost accounting systems in India will require standardized data formats, integrated into existing data management systems, that both meet the needs of policy makers and are acceptable to hospital providers.

With the gradual advancement of The Reform Plan to Control High-value Medical Consumables published by the State Council, the reform policies such as purchase with quantity, charging consumables\" zero bonus\" were born, the operating pressure of medical institutions on medical consumables increased sharply, and the fine cost accounting management demands were improving. Due to the manage features of medical consumables, this will lead to the inaccurate and cross-cycle of cost accounting. In order to achieve the refined cost accounting management, the related business system and process adjustment are studied.

UNASSIGNED: Activity-based costing (ABC) is a costing technique that identifies the activities in an organization and assigns the cost to the activities based on the actual resources consumed for each activity. The method was used to ascertain the cost of surgical intensive care unit (SICU) bed in an institute of national importance, such as All India Institute of Medical Sciences (AIIMS), Bhubaneswar, from June 2019 to February 2021.
UNASSIGNED: The present study aimed to ascertain the cost of SICU beds per day by the ABC technique. The different elements of cost were analyzed. The cost for selected patients in the SICU unit was calculated by preparing a cost sheet based on the elements of cost and studying the existing charging system.
UNASSIGNED: A total of 38 cases were selected from the departments of General Surgery, Urology, Orthopedics, and Plastic surgery. Based on the ABC technique, the activity map was developed for SICU (cost center), and the time consumed together with resources for each activity was calculated with respect to human resources, consumables, medicines, and overheads. Thus, the total cost incurred by the hospital for SICU beds per day was estimated using the cost sheet analysis.
UNASSIGNED: The cost was calculated to be Rs. 11,241/- per day (155 USD) against the hospital charge of Rs. 35/- (<0.5 USD) for general patients and Rs. 1000/- for private ward patients. Exchange Conversion Rate used is 1 USD = 72.60 INR (2020-21).
UNASSIGNED: The public sector hospitals in India provide health-care services for free and at a subsidized rate; hence, ascertaining the cost incurred by the hospital is necessary for policy decisions.

BACKGROUND: The objective is to examine hospital cost accounts to understand the foundation upon which healthcare decisions are based. More specifically, the aim is to add insights to accounting practices and their applicability towards a newly establish value-based agenda with a focus on patient-level cost data.
METHODS: We apply a cost accounting framework developed to position and understand hospital cost practices in relation to government requirements. Allocated cost account data from 2015 from all Danish hospitals were collected and analyzed. These cost accounts lay the foundation for diagnosis related group (DRG) rate setting. We further compare the data\'s limitations and potential in a value-based healthcare (VBHC) agenda with the aim of implementing time-driven activity based costing (TDABC).
RESULTS: We find exceedingly aggregated department-level data that are not tied to patient information. We investigate these data and find large data skewness in the current system, mainly due to structural variances within hospitals. We further demonstrate the current costs data\'s lack of suitability for VBHC but with suggestions of how cost data can become applicable for such an approach, which will increase cost data transparency and, thus, provide a better foundation for both local and national decision-making.
CONCLUSIONS: The findings raise concerns about the cost accounts\' ability to provide valid information in healthcare decision-making due to a lack of transparency and obvious variances that distort budgets and production-value estimates. The standardization of costs stemming from hospitals with large organizational differences has significant implications on the fairness of resource allocation and decision-making at large. Thus, for hospitals to become more cost efficient, a substantially more detailed clinically bottom-led cost account system is essential to provide better information for prioritization in health.

This study proposes a method for calculating the appropriate medical treatment price level for foreign visitors (FVs) in Japan. Hospital management costs and foreign prices were analyzed from a market principles perspective to determine the medical treatment price. The study involved two stages: a preliminary survey and an extended survey, supplemented by an international survey. Relatively frequent diseases were selected, and the costs incurred by hospitals for the treatment of FVs were analyzed though data from three hospitals, covering 24 outpatients and 4 inpatients. Payments made by three insurance companies for overseas medical institution services for Japanese tourists with pharyngitis were analyzed. This study shows that the appropriate medical treatment prices for FVs, considering profits, were 1.22-4.26 times higher compared with prices under Japan\'s public health insurance plans. Furthermore, these prices were 1.31-4.26 times higher for outpatients with pharyngitis and external injury and 1.22-3.66 times higher for inpatients with appendicitis and femoral fractures. The price of pharyngitis treatment in 12 countries was USD 20.32-158.75 per patient for Japanese tourists, whereas FVs paid 60.24 dollars (1.13 times higher than Japan\'s public healthcare price) in Japan. This study shows it was appropriate to set the ideal price level for FVs higher than that for Japanese patients.

Background: Surgical aortic valve replacement (SAVR) has long been the standard treatment for patients with severe aortic stenosis in China, but the costs of SAVR from a hospital perspective in China have not been thoroughly researched. Currently, diagnosis-related groups in China are based on historical expenses that are closely related to the unit charges set by the official pricing department and are frequently inaccurate compared with actual resource consumption. Materials & methods: Through a retrospective empirical study on the costs and charges of SAVR cases in a tertiary hospital, this study aimed to compare the costs and charges of service items. We collected clinical information from patients undergoing SAVR (isolated or concomitant procedures) and financial information from the hospital in 2015 and 2016. Top-down full cost accounting and step-allocation were the main methods used in this study. Result: This research selected 203 SAVR cases in 2015 and 214 cases in 2016. The median length of hospital stay was 15.92 days (6.07 days pre surgery and 9.57 days post surgery). The average human resource cost of care per day per bed in the cardiovascular surgery department, including doctors and nurses, was US $62.22 in 2015 and $66.17 in 2016, but the corresponding charge was no more than $24. For operation, the cost of isolated SAVR was $665 in 2015 and $1015 in 2016, while the charge was $820. For anesthesiology, the cost of isolated SAVR was $400 in 2015 and $526 in 2016, while the average charge was $192. For examination service items, some costs did not exceed charges. The average total cost of a case was $19,299 ± 8954, while the average total charge was $18,923 ± 9194. Conclusion: SAVR is associated with significant resource utilization and hospital stay duration. The fees for human resources and services associated with SAVR do not reflect the true costs of SAVR in a Chinese hospital setting. This study may assist in future budget planning and price setting for policy makers in China.

This article describes the data, data flows, and spreadsheet implementations for linking multi-level contribution margin accounting as a subsystem in cost accounting with several versions of a multi-level fixed-charge problem (MLFCP), the latter based on the optimization approach in operations research. This linkage can reveal previously hidden optimization potentials within the framework of multi-level contribution margin accounting, thus providing better information for decision making in companies and other organizations. For the data, plausible fictitious values have been assumed taking into consideration the calculation principles in cost accounting where applicable. They include resource-related data, market-related data, and data from cost accounting needed to analyze the profitability of a company´s products and organizational entities in the presence of hierarchically structured fixed costs. The data are processed and analyzed by means of mathematical optimization techniques and sensitivity analysis. The linkage between multi-level contribution margin accounting and MLFCP is implemented in three spreadsheet files, including versions for deterministic optimization, stochastic optimization, and robust optimization. This paper provides specifications for compatible solver add-ins and for executing sensitivity analysis. The data and spreadsheet implementations described in this article were used in a research article entitled \"Making better decisions by applying mathematical optimization to cost accounting: An advanced approach to multi-level contribution margin accounting\" [1]. The data sets and the spreadsheet implementations may be reused a) by researchers in management and cost accounting as well as in operations research and quantitative methods for verification and for further development of the linkage concept and of the underlying optimization models; b) by practitioners for gaining insight into the data requirements, methods, and benefits of the proposed linkage, thus supporting continuing education; and c) by instructors in academia who may find the data and spreadsheets valuable for classroom use in advanced courses. The complete spreadsheet implementations in the form of three ready-to-use Excel files (deterministic, stochastic, and robust version) are available for download at Mendeley Data. They may serve as customizable templates for various use cases in research, practice, and education.

Nonnative plant pests cause billions of dollars in damages. It is critical to prevent or reduce these losses by intervening at various stages of the invasion process, including pathway risk management (to prevent pest arrival), surveillance and eradication (to counter establishment), and management of established pests (to limit damages). Quantifying benefits and costs of these interventions is important to justify and prioritize investments and to inform biosecurity policy. However, approaches for these estimations differ in (1) the assumed relationship between supply, demand, and prices, and (2) the ability to assess different types of direct and indirect costs at invasion stages, for a given arrival or establishment probability. Here we review economic approaches available to estimate benefits and costs of biosecurity interventions to inform the appropriate selection of approaches. In doing so, we complement previous studies and reviews on estimates of damages from invasive species by considering the influence of economic and methodological assumptions. Cost accounting is suitable for rapid decisions, specific impacts, and simple methodological assumptions but fails to account for feedbacks, such as market adjustments, and may overestimate long-term economic impacts. Partial equilibrium models consider changes in consumer and producer surplus due to pest impacts or interventions and can account for feedbacks in affected sectors but require specialized economic models, comprehensive data sets, and estimates of commodity supply and demand curves. More intensive computable general equilibrium models can account for feedbacks across entire economies, including capital and labor, and linkages among these. The two major considerations in choosing an approach are (1) the goals of the analysis (e.g., consideration of a single pest or intervention with a limited range of impacts vs. multiple interventions, pests or sectors), and (2) the resources available for analysis such as knowledge, budget and time.

The purpose of multi-level contribution margin accounting in cost accounting is to analyze the profitability of products and organizational entities with appropriate allocation of fixed costs and to provide relevant information for short-term, medium- and longer-term decisions. However, the conventional framework of multi-level contribution margin accounting does not usually incorporate a mathematical optimization method that simultaneously integrates variable and fixed costs to determine the best possible product mix within hierarchically structured organizations. This may be surprising in that operations research provides an optimization model in the form of the fixed-charge problem (FCP) that takes into account not only variable costs but also fixed costs of the activities to be planned. This paper links the two approaches by expanding the FCP to a multi-level fixed-charge problem (MLFCP), which maps the hierarchical decomposition of fixed costs in accordance with multi-level contribution margin accounting. In this way, previously hidden optimization potentials can be made visible within the framework of multi-level contribution margin accounting. Applying the linkage to a case study illustrates that the original assessment of profitability gained on the sole basis of a multi-level contribution margin calculation might turn out to be inappropriate or even inverted as soon as mathematical optimization is utilized: products, divisions, and other reference objects for fixed cost allocation, which at first glance seem to be profitable (or unprofitable) might be revealed as actually unprofitable (or profitable), when the multi-level contribution margin calculation is linked to the MLFCP. Furthermore, the proposed concept facilitates assessment of the costs of an increasing variant diversity, which also demonstrates that common rules on how to interpret a multi-level contribution margin calculation may have to be revised in some cases from the viewpoint of optimization. Finally, the impact of changes in the fixed cost structure and other parameters is tested via sensitivity analyses and stochastic optimization.