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Resumen:Los autores evalúan el coste del consumo de alcohol para el sistema productivo español. Los costes se han clasificado en sanitarios (tratamiento de los accidentes laborales relacionados con el consumo de alcohol) y no sanitarios (subsidio económico por incapacidad temporal y costes debidos a la baja productividad).La cuantificación económica del impacto del alcohol sobre el sistema productivo se estima en 429.617 millones de pesetas. Un 95,5% corresponde a costes no sanitarios, entre los que destacan los costes derivados de la baja productividad, estimados en 288.069 millones de pesetas. Los costes sanitarios por accidente laboral suponen tan sólo un 0,5% (20.329 millones de pesetas).Se concluye que aunque el consumo excesivo de alcohol se ha tratado hasta ahora como un problema básicamente sanitario, su valoración desde una perspectiva más global nos muestra que las auténticas dimensiones del problema van mucho más allá. El importante impacto que supone para el sistema productivo hace sugerir a los autores la necesidad de utilizar un abordaje más intersectorial para afrontar el problema y tener en cuenta todos los costes que origina al destinar los recursos para afrontarlo. Palabras clave: Consumo de alcohol, costes, sistema productivo, España. Summary:Authors asses the costs of alcohol consumption on spanish productive system. The costs have been classified as sanitary costs (treatment of alcohol-related occupational accidents) and non sanitary (sick payment and cost related to productivity decrease).The economic quantification of the impact of alcohol on the productive system is estimated in 429,617 million pesetas. The 95,5% of which is due to non sanitary costs, among these 288,069 millions pesetas drived from productivity decrease. Sanitary costs due to occupational accident amount to only 0,5% (20,329 millions pesetas).In conclusion, although excesive alcohol consumption has so far been treated as a health related issue, a more global view matter suggests that the real dimmensions of it are much wider. Its high impact on the productive system moves the autors to consider an intersectorial aproach together with an assesment of all the costs this would originate.

When resources are limited, the balance between the supply and the demand of nursing care is becoming more and more necessary. This situation justifies the use of tools to measure work charges in nursing. This article analyses the relationship between work charges and time estimation in nursing care. From a bibliographical review on this topic it discusses possibilities and techniques of time estimation for the nursing care given to a patient, as well as the caring time he or she requires. Two different approaches and some conclusions from the analysis of both of them are showed: first; the direct method, i.e. that of measuring caring levels; and secondly, the indirect method, that is a system for classifying patients. The interest of the direct method is advocated because of its clarity, external validation possible integration in nursing care plans.

The length of stay (LOS) of a surgical procedure is influenced both by the real need for medical and nursing care of the patient and also by the practice style of each unit, which can include unjustified stays. The aim of this work was to estimate the appropriate LOS for appendectomy and its differences with the LOS observed in practice. Two hundred and forty-nine medical records (249 admission days and 1447 successive stays) for patients over 6 years old who had had an appendectomy in 1992 were classified by Diagnosis Related Groups (DRG) and reviewed using the Appropriateness Evaluation Protocol. 1.6% of admission days and 31.7% of successive stays were assessed inappropriate. The appropriate LOS for appendectomy was 4.7 days as opposed to 6.8 days of observed LOS. For the DRG 167 (76.3% of the sample) appropriate LOS was 3.4 days (observed LOS 4.9 days). These results suggest the existence of an important proportion of avoidable hospital stays and provides a simple and low cost methodology for assessing the suitability of local hospitalization practices.