Influencia de los sistemas de costes en la eficiencia. Un análisis de los hospitales españoles utilizando bases de datos públicas nacionales

Influence of cost systems on efficiency. An analysis of Spanish hospitals using public national databases

Autores/as

DOI: https://doi.org/10.6018/rcsar.365031
Palabras clave: Costes hospitalarios, Sistemas de contabilidad y control de gestión, Eficiencia, Análisis Envolvente de Datos, Servicio Nacional de Salud, Bases de datos públicas nacionales

Resumen

Este trabajo analiza si el nivel de desarrollo de los sistemas de costes hospitalarios (SC) implementados por los Servicios Regionales de Salud (SRS) españoles tiene algún efecto en la eficiencia de los hospitales. Para ello, utilizamos los datos públicos de 159 hospitales del Sistema Nacional de Salud (SNS) español entre 2010 y 2013, el período de mayores restricciones presupuestarias derivadas de la crisis económica. Aplicamos tres metodologías: primero, un modelo de análisis envolvente de datos (AED) convencional seguido de una regresión Tobit; segundo, un procedimiento de dos pasos con doble bootstrap propuesto por Simar y Wilson (2007), y tercero, el cálculo del índice Malmquist y la aplicación de regresión logística para explicar el cambio en la eficiencia. Encontramos que en el contexto estudiado hay una relación directa entre un SC más desarrollado y la mejora de la eficiencia. Nuestros resultados sugieren que los responsables políticos y los reguladores deberían incentivar el desarrollo de SC hospitalarios estandarizados.

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Abernethy, M.A., Lillis, A.M., Brownell, P., & Carter, P. (2001). Product diversity and costing system design choice: field study evidence. Management Accounting Research, 12(3), 261-279. https://doi.org/10.1006/mare.2001.0168

Al-Omiri, M., & Drury, C. (2007). A survey of factors influencing the choice of product costing systems in UK organizations. Management Accounting Research, 18(4), 399-424. https://doi.org/10.1016/j.mar.2007.02.002

Alonso, J.M., Clifton, J., & Díaz-Fuentes, D. (2015). The impact of New Public Management on efficiency: An analysis of Madrid's hospitals. Health Policy, 119(3), 333-340. https://doi.org/10.1016/j.healthpol.2014.12.001

Álvarez, I.C., Barbero, J., & Zofío, J.L. (2016). A Data Envelopment Analysis Toolbox for MATLAB, Working Papers in Economic Theory 2016/3, Department of Economics, Universidad Autónoma de Madrid, Spain.

Badunenko, O., & Tauchmann, H. (2019). Simar and Wilson two-stage efficiency analysis for Stata. The Stata Journal, 9(4), 950-988. https://doi.org/10.1177/1536867X19893640

Bandrés, E., & González, R. (2015). La reducción del gasto sanitario en España durante la crisis. Cuadernos de Información Económica, 248, 37-48.

Banker, R.D., Charnes, A., & Cooper, W.W. (1984). Some models for estimating technical and scale inefficiencies in data envelopment analysis. Management Science, 30(9), 1078-1092. https://doi.org/10.1287/mnsc.30.9.1078

Banker, R.D., Charnes, A., Cooper, W.W., Swarts, W., & Thomas, D. (1989). An introduction to data envelopment analysis with some of its models and their uses. Research in Governmental and Nonprofit Accounting, 5(1), 125-163.

Escobar-Rodríguez, T., & Bartual-Sopena, L. (2015). Impact of cultural factors on attitude toward using ERP systems in public hospitals. Revista de Contabilidad-Spanish Accounting Review, 18(2), 127-137. https://doi.org/10.1016/j.rcsar.2014.04.002

Brierley, J.A. (2008). Toward an understanding of the sophistication of product costing systems. Journal of Management Accounting Research, 20(s1), 61-78. https://doi.org/10.2308/jmar.2008.20.s-1.61

Busse, R., Schreyögg, J., & Smith, P.C. (2008). Variability in healthcare treatment costs amongst nine EU countries--results from the HealthBASKET project. Health Economics, 17(S1), S1-S8. https://doi.org/10.1002/hec.1330

Caballer-Tarazona, M., & Vivas-Consuelo, D. (2016). A cost and performance comparison of Public Private Partnership and public hospitals in Spain. Health Economics Review, 6(1), 17. https://doi.org/10.1186/s13561-016-0095-5

Calzado Cejas, Y. (2005). Sistemas de salud: una adaptación del modelo de contingencia de Luder al sector sanitario. Navarra: Thomson-Civitas.

Calzado Cejas, Y., García Valderrama, T., Laffarga Briones, J., & Larrán Jorge, M. (1998). Relación entre eficiencia y efectividad en los hospitales del servicio andaluz de salud. Revista de Contabilidad-Spanish Accounting Review, 1(2), 49-83.

Cardinaels, E., Roodhooft, F., & Van Herck, G. (2004). Drivers of cost system development in hospitals: results of a survey. Health Policy, 69(2), 239-252. https://doi.org/10.1016/j.healthpol.2004.04.009

Chang, H., Chang, W.J., Das, S., & Li, S.H. (2004). Health care regulation and the operating efficiency of hospitals: Evidence from Taiwan. Journal of Accounting and Public Policy, 23(6), 483-510. https://doi.org/10.1016/j.jaccpubpol.2004.10.004

Chapman, C., Kern, A., & Laguecir, A. (2014). Costing practices in healthcare. Accounting Horizons, 28(2), 353-364. https://doi.org/10.2308/acch-50713

Chapman, C.S., Kern, A., Laguecir, A., & Quentin, W. (2016). Management accounting and efficiency in health services: the foundational role of cost analysis. In J. Cylus, I. Papanicolas and P.C. Smith (Eds.), Health system efficiency: How to make measurement matter for policy and management (pp.75-98). World Health Organization.

Charnes, A., Cooper, W.W., & Rhodes, E. (1978). Measuring the efficiency of decision making units. European Journal of Operational Research, 2(6), 429-444. https://doi.org/10.1016/0377-2217(78)90138-8

Drury, C., & Tayles, M. (2005). Explicating the design of overhead absorption procedures in UK organizations. The British Accounting Review, 37(1), 47-84. https://doi.org/10.1016/j.bar.2004.08.003

Eldenburg, L.G., & Krishnan, R. (2008). The influence of ownership on accounting information expenditures. Contemporary Accounting Research, 25(3), 739-772. https://doi.org/10.1506/car.25.3.4

Eldenburg, L.G., Krishnan, H.A., & Krishnan, R. (2017). Management Accounting and Control in the hospital industry: a Review. Journal of Governmental & Nonprofit Accounting, 6(1), 52-91. https://doi.org/10.2308/ogna-51922

Franco Miguel, J.L., Fullana Belda, C., & Rúa Vieites, A. (2018). Analysis of the technical efficiency of the forms of hospital management based on public‐private collaboration of the Madrid Health Service, as compared with traditional management. The International Journal of Health Planning and Management. 1-29. https://doi.org/10.1002/hpm.2678

Franco-Miguel, J.L., & Fullana-Belda, C. (2020). Influencia de los modelos de gestión basados en la colaboración público-privada en la eficiencia técnica e investigadora de los hospitales del sistema sanitario público. Revista de Contabilidad-Spanish Accounting Review, 23(1), 50-63. https://doi.org/10.6018/rcsar.389261

García-Cornejo, B., & Pérez-Méndez, J.A. (2018a). Relación entre sistemas de costes y gasto hospitalario. Gaceta Sanitaria, 32(2), 158-165. https://doi.org/10.1016/j.gaceta.2017.06.002

García-Cornejo, B., & Pérez-Méndez, J.A. (2018b): Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level. Health Policy, 122(4), 396-403. https://doi.org/10.1016/j.healthpol.2018.01.013

Gok, M.S., & Altındağ, E. (2015). Analysis of the cost and efficiency relationship: experience in the Turkish pay for performance system. The European Journal of Health Economics, 16(5), 459-469. [https://doi.org/10.1007/s10198-014-0584-6]{.underline}

Hill, N.T. (2000). Adoption of costing systems in US hospitals: An event history analysis 1980--1990. Journal of Accounting and Public Policy, 19(1), 41-71. https://doi.org/10.1016/S0278-4254(99)00013-7

Hung, J.H., & Chang, L. (2008). Has cost containment after the National Health Insurance system been successful?: Determinants of Taiwan hospital costs. Health Policy, 85(3), 321-335. https://doi.org/10.1016/j.healthpol.2007.09.005

Hussey, P.S., Wertheimer, S., & Mehrotra, A. (2013). The association between health care quality and cost: a systematic review. Annals of Internal Medicine, 158(1), 27-34.

Instituto de Información Sanitaria (2012). Análisis de los sistemas de contabilidad analítica en los hospitales del SNS. Vol. I. Informe. [Publicación en Internet]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad (2012). Available at: https://www.mscbs.gob.es/estadEstudios/estadisticas/docs/Informe_SCA_hospitalarios_en_SNS_WEB.pdf

Instituto Nacional de la Salud (INSALUD) (2001a). Resultados de la gestión analítica en los hospitales del INSALUD. GECLIF 2000, Ministerio de Sanidad y Consumo, Subdirección General de Atención Especializada, Madrid. Available at: http://www.ingesa.mscbs.gob.es/en/bibliotecaPublicaciones/publicaciones/internet/docs/gesAnalitica.pdf

Instituto Nacional de la Salud (INSALUD) (2001b). GECLIF. Gestión clínico-financiera y coste por proceso. Madrid: Ministerio de Sanidad y Consumo, Subdirección General de Coordinación Administrativa; 2001. Available at: http://www.ingesa.mscbs.gob.es/bibliotecaPublicaciones/publicaciones/internet/docs/geClif.pdf

Istituto Superiore di Sanità, (2018). It.DRG Project: state of the art. Rapporti ISTISAN 18/12. Available at: http://old.iss.it/binary/publ/cont/18_12_web.pdf#page=134

Kaplan, R.S., & Porter, M.E. (2011). How to solve the cost crisis in health care. Harvard Business Review, 89(9), 46-52.

Krumwiede, K.R., Suessmair, A., & MacDonald, J. (2014). A framework for measuring the complexity of cost systems (August 17, 2013). AAA 2014 Management Accounting Section (MAS) Meeting Paper (2014). Available at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2311720

Labro, E., & Stice-Lawrence, L. (2018) Updating accounting systems: Long-Run evidence from the healthcare sector. 2018. Available at: https://msbfile03.usc.edu/digitalmeasures/sticelaw/intellcont/Labro%20Stice%20Aug%2013%202018-1.pdf

Lawrence, C.M. (1990). The effect of ownership structure and accounting system type on hospital costs. Research in Governmental and Nonprofit Accounting, 6, 35-60.

Lehtonen, T. (2007). DRG-based prospective pricing and case-mix accounting---Exploring the mechanisms of successful implementation. Management Accounting Research, 18(3), 367-395. https://doi.org/10.1016/j.mar.2006.12.002

Lindlbauer, I., Schreyögg, J., & Winter, V. (2016). Changes in technical efficiency after quality management certification: A DEA approach using difference-in-difference estimation with genetic matching in the hospital industry. European Journal of Operational Research, 250(3), 1026-1036. https://doi.org/10.1016/j.ejor.2015.10.029

Lüder, K. (1994). The 'contingency model'reconsidered: experiences from Italy, Japan and Spain. In E. Buschor and K. Schedler (Eds.) Perspectives on Performance Measurement and Public Sector Accounting (pp. 1-15). Haupt.

Macinati, M.S., & Anessi-Pessina, E. (2014). Management accounting use and financial performance in public health-care organisations: Evidence from the Italian National Health Service. Health Policy, 117(1), 98-111. https://doi.org/10.1016/j.healthpol.2014.03.011

Maddala, G.S. (1986). Limited-dependent and qualitative variables in econometrics (No. 3). Cambridge university press.

Martínez Franco, C.M., & Guzmán Raja, I. (2014). Medida de la eficiencia en entidades no lucrativas: un estudio empírico para fundaciones asistenciales. Revista de Contabilidad-Spanish Accounting Review, 17(1), 47-57. https://doi.org/10.1016/j.rcsar.2013.08.005

Ministry of Health, Consumption and Social Welfare. Subdirección General de Información Sanitaria e Innovación. Estadística de Centros de Atención Especializada [SIAE]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad. Available at: https://www.mscbs.gob.es/estadEstudios/estadisticas/estHospiInternado/inforAnual/homeESCRI.htm

Ministry of Health, Consumption and Social Welfare. ICMBD (Indicadores y ejes de análisis del CMBD). Ministerio de Sanidad, Consumo y Bienestar Social. Available at: http://icmbd.es/login-success.do

O'Neill, L., Rauner, M., Heidenberger, K., & Kraus, M. (2008). A cross-national comparison and taxonomy of DEA-based hospital efficiency studies. Socio-Economic Planning Sciences, 42(3), 158-189. https://doi.org/10.1016/j.seps.2007.03.001

Pérez-Romero, C., Ortega-Díaz, M.I., Ocaña-Riola, R., & Martín-Martín, J.J. (2017). Análisis de la eficiencia técnica en los hospitales del Sistema Nacional de Salud español. Gaceta Sanitaria, 31(2), 108-115. https://doi.org/10.1016/j.gaceta.2016.10.007

Pérez-Romero, C., Ortega-Díaz, M.I., Ocaña-Riola, R., & Martín-Martín, J.J. (2019). Análisis multinivel de la eficiencia técnica de los hospitales del Sistema Nacional de Salud español por tipo de propiedad y gestión. Gaceta Sanitaria, 33, 325-332. https://doi.org/10.1016/j.gaceta.2018.02.005

Pizzini, M.J. (2006). The relation between cost-system design, managers' evaluations of the relevance and usefulness of cost data, and financial performance: an empirical study of US hospitals. Accounting, Organizations and Society, 31(2), 179-210. https://doi.org/10.1016/j.aos.2004.11.001

Porter, M.E. (2010). What is value in health care? New England Journal of Medicine, 363(26), 2477-2481. https://doi.org/10.1056/NEJMp1011024

Prior, D., Martín-Pinillos-Castellanos, I., Pérez-López, G., & Zafra-Gómez, J.L. (2019). Condición financiera y eficiencia en los gobiernos locales de las Islas Canarias en tiempos de crisis financiera. Revista de Contabilidad-Spanish Accounting Review, 22(2), 129-144. https://doi.org/10.6018/rcsar.376091

Puig Junoy, J. (1988). La función de costes hospitalarios. Estudio de 151 hospitales. Gaceta Sanitaria, 2(5), 68-72. https://doi.org/10.1016/S0213-9111(88)70904-8

Rego, G., Nunes, R., & Costa, J. (2010). The challenge of corporatisation: the experience of Portuguese public hospitals. The European Journal of Health Economics, 11(4), 367-381. https://doi.org/10.1007/s10198-009-0198-6

Schoute, M. (2009). The relationship between cost system complexity, purposes of use, and cost system effectiveness. The British Accounting Review, 41(4), 208-226. https://doi.org/10.1016/j.bar.2009.10.001

Schoute, M., & Budding, T. (2017a). Stakeholders' information needs, cost system design, and cost system effectiveness in Dutch Local Government. Financial Accountability & Management, 33(1), 77-101. https://doi.org/10.1111/faam.12116

Schoute, M., & Budding, T. (2017b). Changes in Cost System Design and Intensity of Use in Times of Crisis: Evidence from Dutch Local Government. In Malina, M.A. (Ed.) Advances in Management Accounting (pp. 1-31). Emerald Publishing Limited.

Sharma, L., Chandrasekaran, A., Boyer, K.K., & McDermott, C.M. (2016). The impact of health information technology bundles on hospital performance: An econometric study. Journal of Operations Management, 41, 25-41. https://doi.org/10.1016/j.jom.2015.10.001

Simar, L., & Wilson, P.W. (2007). Estimation and inference in two-stage, semi-parametric models of production processes. Journal of Econometrics, 136(1), 31-64. https://doi.org/10.1016/j.jeconom.2005.07.009

Sloan, F.A., Feldman R.D., & Steinwald A.B. (1983). Effects of teaching on hospital costs. Journal of Health Economics, 2(1), 1-28. https://doi.org/10.1016/0167-6296(83)90009-7

Sociedad Española de Calidad Asistencial (SECA) (2012). Indicadores de calidad para hospitales del Sistema Nacional de Salud. 2012. Available at: http://www.calidadasistencial.es/images/gestion/biblioteca/335.pdf

Solana, J., Ibáñez, N., & Benito, B. (2017). Determinantes de la eficiencia en las fundaciones españolas. Revista de Contabilidad-Spanish Accounting Review, 20(2), 176-194. https://doi.org/10.1016/j.rcsar.2016.12.00

Sorenson, C., Drummond, M., & Khan, B.B. (2013). Medical technology as a key driver of rising health expenditure: disentangling the relationship. ClinicoEconomics and outcomes research: CEOR, 5, 223. [https://doi.org/[10.2147/CEOR.S39634]]{.underline}

Szczesny, A., & Ernst, C. (2016). The Role of Performance Reporting System Characteristics for the Coordination of High-Cost Areas in Hospitals. European Accounting Review, 25(4), 635-660. https://doi.org/10.1080/09638180.2016.1210525

Subdirección General de Información Sanitaria e Innovación (2013). Guía de recomendaciones para la obtención homogénea de costes de hospitalización en el SNS. [Publicación en Internet]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad. Available at: [https://www.mscbs.gob.es/estadEstudios/estadisticas/docs/REC_OBT_HOM_COST_HOSPIT_SNS.pdf]{.underline}

Tan, S.S., Rutten, F.F.H., Van Ineveld, B.M., Redekop, W.K., & Hakkaart-van Roijen, L. (2009). Comparing methodologies for the cost estimation of hospital services. The European Journal of Health Economics, 10(1), 39-45. https://doi.org/10.1007/s10198-008-0101-x

Thanassoulis, E. (2001). Introduction to the theory and application of data envelopment analysis. Dordrecht: Kluwer Academic Publishers.

Tiemann, O., & Schreyögg, J. (2012). Changes in hospital efficiency after privatization. Health Care Management Science, 15(4), 310-326. https://doi.org/10.1007/s10729-012-9193-z

Vitaliano, D.F. (1987). On the estimation of hospital cost functions. Journal of Health Economics, 6(4), 305-318. https://doi.org/10.1016/0167-6296(87)90018-X

Wooldridge, J.M. (2002). Econometric analysis of cross section and panel data. Cambridge, Massachusetts: MIT Press.

Wu, V.Y., Shen, Y.C., Yun, M.S., & Melnick, G. (2014). Decomposition of the drivers of the US hospital spending growth, 2001--2009. BMC Health Services Research, 14(1), 230. https://doi.org/10.1186/1472-6963-14-230

Publicado
01-07-2020
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García-Cornejo, B., & Pérez-Méndez, J. A. (2020). Influencia de los sistemas de costes en la eficiencia. Un análisis de los hospitales españoles utilizando bases de datos públicas nacionales: Influence of cost systems on efficiency. An analysis of Spanish hospitals using public national databases. Revista De Contabilidad - Spanish Accounting Review, 23(2), 249-262. https://doi.org/10.6018/rcsar.365031
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