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The costs of hospital services: a case study of Evangelical Lutheran Church hospitals in Tanzania

HEALTH POLICY AND PLANNING 1998年第4期13卷 397-407页

作者： Flessa, S Univ Erlangen Nurnberg Sch Management D-90020 Nurnberg Germany

The health care systems of many developing countries are facing a severe crisis. Problems of financing services leads to high patient fees which make institutions of Western health care unaffordable for the majority of the rural poor. The conflict between sustainability and affordability of the official health care system challenges both local decision-makers and health management consultants. Decisions must be made soon so that the existing health care systems can survive. However, these decisions must be based on sound data, especially on the costs of health care services. The existing accounting systems of most hospitals in developing countries do not provide decision-makers with these data. Costs are generally underestimated. The leadership of the 16 hospitals of the Evangelical Lutheran Church in Tanzania is currently analyzing how the existing health care services should be restructured. Therefore, reliable estimates of the costs of hospitals services are required. A survey on 'Costing of health services of the Evang. Luth. Church in Tanzania' was prepared, which summarizes the results of seven months of field investigations in Lutheran hospitals. The major findings are that the costs of providing adequate services are much higher than expected. The most important factors determining these costs are the administrative efficiency of the hospital and the scope of services offered. The paper closes with some recommendations on how to improve the services in order to make them both affordable for the rural poor and financially sustainable for the Church. It is concluded that even the best improvement of technical efficiency will not safeguard the survival of the hospital-based health care services of the Lutheran Church in Tanzania. These findings call for a reallocation of health care resources to lower levels of the health care pyramid.

关键词：基督教费用分配发展中国家/经济学效率组织设备和供应医院/经济学卫生政策卫生服务研究/方法医院费用/统计学和数值数据医院宗教/经济学医院宗教/组织和管理组织状况研究坦桑尼亚

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Teaching total quality management: developing and deploying education throughout a healthcare system.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1997年第2期19卷 17-23,26页

作者： Kleeb, T.E. Omaha Veterans Administration Medical Center NE USA.

Healthcare organizations are faced with the responsibility of teaching their entire staff the founding principles, concepts, and practices of total quality management (TQM), to improve organizational effectiveness. Purchasing training products from outside consultants can be costly, but healthcare leaders can design and develop their own TQM training products, integrating each product with their organization's mission and values. This article describes how a Catholic healthcare system successfully developed and deployed a compendium of TQM educational products throughout the health-care system.

关键词：天主教成本及成本分析卫生人员/教育医院宗教/组织和管理医院宗教/标准在职培训/组织和管理模型教育模型组织管理多机构系统/组织和管理多机构系统/标准组织文化软件设计教材全面质量管理/方法美国人类

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Collaboration: a framework for clinical quality improvement.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1997年第4期19卷 10-17页

作者： Kleeb, T.E. Catholic Health Corporation Omaha NE United States

Healthcare organizations are being challenged to find ways to leverage improvement efforts. Collaboration offers an avenue for working together toward a common goal. Healthcare leaders can initiate collaborative projects to analyze common clinical problems and to share best practices. This article describes how a Catholic healthcare system successfully initiated a systemwide collaborative clinical quality improvement project to deal with patient falls.

关键词：教育继续效率组织医院宗教/组织和管理医院宗教/标准机构间关系模型组织管理全面质量管理/方法美国人类

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