The Allocation of Costs of University Hospitals: An Overview of Methods Used in the Netherlands

Snijders, E.H.M.; Sol, J.C.A.; Schepers, Jörg; Stevens, Fred; Groot, Linda

doi:10.1111/j.1468-0408.1987.tb00198.x

Cited by 7 publications

(5 citation statements)

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“…We are not aware of similar British studies and so can make no direct comparisons. However, the percentage of total clinical academics' time spent teaching which we recorded as around 5% corresponds to the range of 3–6% found in the Dutch study (Snijders et al 1987). Since about half of their time is contracted to provide clinical service to the NHS, the 5% quoted above represents about 10% of the time committed to the university, spent in face‐to‐face teaching.…”

Section: Results and Validationsupporting

confidence: 66%

“…If one were to measure all the outputs in this way considerable double counting would result. Snijders et al (1987) used a decision tree, which depended on the number of students and the type of activity. However, this gave a series of predetermined weights and thus did not allow for any between‐teacher variation.…”

Section: Discussionmentioning

confidence: 99%

“…One way round this is to use outside observers to record the teaching. Snijders et al (1987) report a 3‐year study which used new medical graduates to follow and observe the activities of various medical and paramedical staff. By the use of decision trees, joint activities such as service and teaching were apportioned to different activities.…”

Section: Methodsmentioning

confidence: 99%

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The student diary survey: a method of monitoring hospital-based medical education

1991

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A new system of allocating the Service Increment for Teaching (SIFT) has recently been introduced which, by its nature, encourages universities to be more explicit about their teaching requirements. A detailed study of the quantity of teaching received by Leicester clinical medical students was carried out using a student diary. This instrument enables a data base to be constructed which is useful for academic and resource allocation purposes. This information can also be used to estimate the teaching time in the different sites and the source of funding of the teaching staff and thereby provide insights into the 'knock-for-knock' system of informal cost-sharing between universities and the National Health Service.

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Section: Results and Validationsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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The student diary survey: a method of monitoring hospital-based medical education

1991

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“…As regards the impact of research on the length of stays, we found no relationship between the intensity of scientific production and the duration of stays. Only two studies examined the scientific production effect on the length of stay (Lave and Franck, 1990; Snijders et al ., 1987). They suggested that lengths of stay are likely to be higher in teaching hospitals.…”

Section: Discussionmentioning

confidence: 99%

The impact of research on hospital costs of care: an empirical study

2010

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The goal of this study was to examine the impact of research activities on hospital costs and lengths of stay in French public hospitals. Our data consist of a random sample of 30000 inpatient stays in 38 hospitals that were extracted from the French Hospital Cost Survey database. Hospital characteristics were added using data from a French national survey and performing a bibliometric study. This is a retrospective study of hospitalizations. We used multilevel modelling. We considered separate models to explain the cost per day and the length of hospital stay (LOS). Research output was defined based on the quartiles of the distribution of the number of impact-weighted scientific publications produced in our sample of hospitals over a 6-year period. Research production was associated with a higher cost of care. The cost per day was 19% higher in hospitals in the 3rd quartile and 42% higher in hospitals in the 4th quartile compared to that in hospitals that were not involved in research activities. This result was sensitive to the type of care under consideration. The effect was stronger in oncology but not significant in routine care. Scientific production did not impact the LOS.

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“…Thirdly, it is difficult to identify separately the costs of teaching because of the methodological problems associated with costing joint products,7 8 for example, allocating the costs of rearing sheep to the production of mutton and wool. Consider the problem of allocating costs when a patient's case is being used to teach undergraduates, to train registrars and nurses, and is also being included as part of a randomised controlled trial.…”

Section: Excess Costsmentioning

confidence: 99%

The medical service increment for teaching (SIFT): a 400m anachronism for the English NHS?

Bevan

1999

BMJ

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In 1997-8, over £400m ($640m) of NHS money was designated as the medical service increment for teaching (SIFT). 1 The manifest purpose of SIFT is to ensure that the NHS supports quality and innovation in undergraduate medical education. This includes supporting the increasing role of teaching in hospitals other than the main university hospital affiliated with each medical school, general practices, and other community settings.2 3 SIFT is designed to be paid in addition to income gained by medical schools for teaching medical students. The latent purpose of SIFT, which paradoxically dominates its distribution, is to ensure a "level playing field" in the healthcare market by covering "historic infrastructure costs, whether or not they are currently required for education."2 As designed, SIFT is thus in conflict with one of the aims of the government's white paper, The New NHS, which sought to end the way in which instability in the healthcare market resulted in "shoring up the status quo rather than creating the space to plan and implement major improvement." 4 Allocations of SIFT are based on the product of the annual SIFT rate (about £36 000 for institutions outside London and £39 000 in London) and the number of whole time equivalent students who are in the last three years of the five year curriculum, which are traditionally the years of clinical teaching.2 Thus a medical school that has an annual intake of 150 students will have about £16m in SIFT funding available for distribution to healthcare trusts and general practices that teach students. In 1996-7, nearly 90% of SIFT funds were allocated to the main acute teaching trusts (or teaching hospitals); most of the £170m allocated to the Thames regions is spent in London.1 Details are not published, but income from SIFT for the main university hospital may exceed £10m annually (and may also be its second most important source of income after the local health authority).This paper examines the way in which rates of SIFT funding have been estimated and interprets the results of these allocations. It does not consider the allocation of SIFT for dental students. This paper argues that current policies conflict with the objectives of equity and efficiency expressed in The New NHS. 4 Excess costsExcess costs of main university hospitals There are three troubling facts about the costs of running the main university hospitals. Firstly, simply dividing total hospital costs by the total number of cases shows that the main university hospitals have high unit costs; thus, they seem to be inefficient. The most recent published empirical basis for the current SIFT allocations, compiled for the 1988 review of the Resource Allocation Working Party 5 by Foote et al,6 reported that the costs per case at the main university hospitals in 1984-5 were about 30% higher than those in non-teaching hospitals. These excess costs may be accounted for by the costs incurred in teaching medical students, supporting research, the further training of doctors, and for providing specialised ...

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The Allocation of Costs of University Hospitals: An Overview of Methods Used in the Netherlands

Cited by 7 publications

References 0 publications

The student diary survey: a method of monitoring hospital-based medical education

The student diary survey: a method of monitoring hospital-based medical education

The impact of research on hospital costs of care: an empirical study

The medical service increment for teaching (SIFT): a 400m anachronism for the English NHS?

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