Evaluando la situación financiera de los hospitales públicos a partir de los costos actualizados de sus prestaciones

Abstract

In 2011 the Chilean National Health Fund (FONASA) commissioned a study to assess the costs of the 120 most relevant hospital care services with an established fee, in a large sample of public hospitals. We herein report the cost evaluation results of such study, considering the financial condition of those hospitals in the year of the study. Based on the premise that the expenses derived from the provision of institutional and appraised hospital services should be identical to the billing of hospitals to FONASA, the prices are undervalued, since they cover only 56% of billing, generating a gap between expenses and invoicing. This gap shows an important limitation of tariffs, since their prices do not cover the real costs. However not all hospitals behave in the same way. While the provision of services of some hospitals is even higher than their billing, most hospitals do not completely justify their invoicing. These assumptions would imply that, generally speaking, hospital debts are justified by the costs incurred. However, hospitals have heterogeneous financial situations that need to be analyzed carefully. In particular, nothing can be said about their relative efficiency if cost estimations are not adjusted by the complexity of patients attended and comparison groups are not defined.

Costs of examinations performed in a hospital laboratory in Chile

“…The F-IAM fee was compared with the CMT for a selected group of examinations. The profitability (14) of each examination was calculated as the difference between the F-IAM fee and the CMTexpressed as a percentage of the F-IAM fee. Finally, and given the total number of examinations performed for each type of examination selected, the total production cost (TPC) of examinations was compared with the total income (TI) derived from the total contribution by the F-IAM fee.…”

Cost analysis of chronic pain due to musculoskeletal disorders in Chile

“…In addition, it might be even underestimating the high costs found in this study. As shown in a study about hospital financial situation [ 31 ], calculated health services costs are significantly higher than the government fees, as they cover only 43% of the actual cost. It indeed produces an underestimation of the cost, affecting the estimations provided in this study.…”

Gastos hospitalarios por neumonía neumocóccica invasora en adultos en un hospital general en Chile

“…Además, sólo estiman los gastos de la forma más frecuente de ENI en adultos, pero no la forma localizada más frecuente que es la neumonía neumocóccica y los estudios en niños en Chile, han al menos establecido menores costos para esta forma más frecuente. Por otra parte, los cálculos fueron realizados de acuerdo a los valores establecidos por el seguro público de salud, que reconocidamente ha sido criticado por no cubrir los costos reales de las prestaciones de salud y, por lo tanto, nuestras estimaciones podrían ser muy inferiores al costo real 21 . A pesar de estas limitaciones, este trabajo entrega por primera datos económicos sobre el gasto directo (no consideró gastos indirectos) para la forma más frecuente de ENI en adultos y sus diferencias de acuerdo al tipo de unidad de hospitalización.…”