[Activity and cost in hospitals managed by INSALUD in 1990-1993]. / Análisis de actividad y gasto en los hospitales del INSALUD de 1990 a 1993.

BACKGROUND: The improvement of the efficiency of the hospitals is a common objective in all the Health Systems. In the last years, different management measures have been implemented in the territory directly managed by Insalud, looking for a continuous improvement of the hospital efficiency. In this paper we analyze the activity and the expenses during the last four years in the Insalud managed hospitals. METHODS: A descriptive study of activity and costs during the last four years has been done in all 88 hospitals and also by groups, using usual indicators of intermediary products and activity and costs measured by UPAs. RESULTS: A global increase of activity is shown: inpatients, outpatients and surgery (above all ambulatory surgery) with a decrease of the average stay and an increase of the rotation index. The activity measured in UPAs has increased in a 2.54% in 1993 compared to 1992 and the UPA cost in constant pesetas has been reduced in 688 pesetas in the same period. The different groups of hospitals are developing a more homogeneous behaviour regarding production indicators as well as costs. CONCLUSIONS: The different management measures implemented in the last years have produced an increase of the activity and of the expenses control leading to less financial increases to perform more hospital activity.

[The weighted health care unit: a new tool for hospital budgeting]. / La unidad ponderada asistencial (UPA): nueva herramienta para la presupuestación hospitalaria.

Hospital budgets must be based on estimated workload in order to fairly distribute available financial resources. A tool to measure hospital production is need to achieve this aim. We present in this article the results of a study on hospital cost which was carried out to design a new unit for measuring intermediate hospital products: the Weighted Health Care Unit (Unidad Ponderada Asistencial: UPA). Thereafter we use multiple regression to find out structure, services and activity variables which explain the variations in expenses per UPA among 64 hospitals of INSALUD. Significant variables include: doctors per hospital bed, hospital staff (sanitary personnel except doctors plus administrative assistants) per bed, hospital size (less than 200 beds), ICU beds percentage, oncology service, UPAs per bed average length of stay. These variables, along with interactions between them, explain 91.4% of the variance of expenses per UPA. The UPA and statistical modeling allow a better understanding of hospital expenses and can be very useful in coordinating budgets to hospital activity taking into account the different characteristics of each hospital.