Based on knowledge capital value for disease cost accounting of diagnosis related groups.

Background: The National Health Commission and the other relevant departments in China have initiated testing of the Diagnosis Related Groups (DRGs) system in 30 pilot locations since 2019. In the process of DRG payment reform, accounting for the costs of diseases has become a highly challenging issue. The traditional method of disease accounting method overlooks the compensation for the knowledge capital value of medical personnel. Objective: The primary objective of this study is to analyze the cost accounting scheme of China's Diagnosis Related Groups (C-DRG), focusing on the value of knowledge capital. Methods: The study initially proposes a measurement index system for the value of knowledge-based capital, including the difficulty of disease treatment, labor intensity of disease treatment, risk of disease treatment, and operation/treatment time for diseases. The Analytic Hierarchy Process (AHP) is then utilized to weigh the features of medical workers' knowledge capital value. First, pairwise comparisons are conducted in this stage to develop a two-pair judgment matrix of the primary indicators. Second, the eigenvectors corresponding to the maximum eigenvalues of the matrix are calculated to generate the weight coefficient of each feature. The consistency test is carried out after this stage. An empirical analysis is conducted by collecting data, including the full costs of treating three types of diseases-hip replacement, acute simple appendicitis, and heart bypass surgery-from one public medical institution. Results: The empirical analysis examines whether this DRG costing accounting can address the issue of neglecting the value of medical workers' knowledge capital. The methods reconfigure the positive incentive mechanism, stimulate the endogenous motivation of the medical service system, foster independent changes in medical behavior, and achieve the goals of reasonable cost control. Conclusion: In the cost accounting system of C-DRG, the value of medical workers' knowledge capital is acknowledged. This acknowledgment not only boosts the enthusiasm and creativity of medical workers in optimizing and standardizing the diagnosis and treatment process but also improves the transparency and authenticity of DRG pricing. This is particularly evident in the optimization and standardization of the diagnosis and treatment processes within medical institutions and in monitoring inadequate medical practices within these institutions.

Healthcare cost accounting in the Indian hospital sector.

Setting reimbursement rates in national insurance schemes requires robust cost data. Collecting provider generated cost accounting information is a potential mechanism for improving the cost evidence. To inform strategies for obtaining cost data to set reimbursement rates, this analysis aims to describe the role of cost accounting in public and private health sectors in India and describe the importance, perceived barriers, and facilitators to improving cost accounting systems. In-depth interviews (IDI) were conducted with 11 key informants. The interview tool guide was informed by a review of published and grey literature and government websites. The interviews were recorded for both audio and video and transcribed. A thematic coding framework was developed for the analysis. Multiple discussions were held to add, delete, classify, or merge the themes. The themes identified were: the status of cost accounting in the Indian hospital sector, legal and regulatory requirements for cost reporting, challenges to implementing cost accounting, and recommendations for improving cost reporting by healthcare providers. The findings indicate that the sector lacks maturity in cost accounting due to a lack of understanding of its benefits, limited capacity, and weak enforcement of cost reporting regulations. Providers recognize the value of cost analysis for investment decisions but have mixed opinions on the willingness to gather and report cost information, citing resource constraints and a lack of trust in payers. Additionally, heterogeneity among providers will require tailored approaches in developing cost accounting reporting frameworks and regulations. Healthcare cost accounting systems in India are rudimentary with a few exceptions, raising questions about how to source these data sustainably. Strengthening cost accounting systems will be contingent upon developing standardized formats that generate sufficient information for policymaking, are acceptable to private providers, and can be integrated with the existing data management systems.

Beyond the Food Systems Summit: Linking Recommendations to Action-The True Cost of Food.

A transformation of food systems is needed to achieve the 17 Sustainable Development Goals specified in the 2030 Agenda for Sustainable Development. Recognizing the true costs and benefits of food production and consumption can help guide public policy decisions to effectively transform food systems in support of sustainable healthy diets. A new, expanded framework is presented that allows the quantification of costs and benefits in three domains: health, environmental, and social. The implications for policy makers are discussed. Curr Dev Nutr 2023;x:xx.

Assessing Digital Transformation of Cost Accounting Tools in Healthcare.

The expansion of digital technologies has significantly changed most economic activities and professions. Digital technologies penetrated managerial accounting and have a vast potential to transform this profession. Implementing emerging digital technologies, such as artificial intelligence, blockchain, the Internet of Things, big data, and cloud computing, can trigger a crucial leap forward, leading to a paradigm-shifting in healthcare organizations' accounting management. The paper's main objective is to investigate the perception of Romanian accountants on implementing digital technologies in healthcare organizations' accounting management. The paper implies a study based on a questionnaire among Romanian accountants who use various digital technologies implemented in traditional and innovative cost accounting tools. Based on structural equation modeling, the results emphasize the prevalence of innovative tools over traditional cost accounting tools improved through digital transformation, digital technologies assuming the most complex and time-consuming tasks. Moreover, the influence of cost accounting tools improved through digital transformation on healthcare organizations' performance is much more robust in the case of innovative tools than in the case of traditional cost accounting tools. The proposed model provides managers in healthcare organizations with information on the most effective methods in the context of digital transformation.

[Exploration and Thinking on Fine Management of Cost Accounting of Medical Consumables].

With the gradual advancement of The Reform Plan to Control High-value Medical Consumables published by the State Council, the reform policies such as purchase with quantity, charging consumables" zero bonus" were born, the operating pressure of medical institutions on medical consumables increased sharply, and the fine cost accounting management demands were improving. Due to the manage features of medical consumables, this will lead to the inaccurate and cross-cycle of cost accounting. In order to achieve the refined cost accounting management, the related business system and process adjustment are studied.

Research on cost accounting of enterprise carbon emission (in China).

Enterprises in China face two major challenges about their existence and energy supply at present. One is the difficulty in providing enough energy at an acceptable and reasonable price; the other is a severe environmental issue caused by over-consumption of energy. The government and relevant enterprises, therefore, mainly focus on carbon emission reduction, and the cost accounting of carbon emission, an essential prerequisite, and object of carbon emission reduction, should be further attention. The carbon emission cost is divided into internal cost and external cost, combined with the extended accounting model and cost calculation. This can comprehensively measure and reflect the two costs of the life cycle of the product, provide more relevant data and information support for the deepening and development of the circular economy, and provide an effective cost information basis and guide enterprise managers for scientific decision-making and governance.

Material flow cost accounting (MFCA) to enhance environmental entrepreneurship in the meat sector: Challenges and opportunities.

The material flow cost accounting (MFCA) is one of the most broadly standardized tools accepted in environmental, social and economic research, which traces and quantifies material flows and stock in physical and economic units. Although its application has been recently developed in the field of resource and waste management, few academic articles have investigated its value towards food waste management, which represents a topical concern on a global scale. The present research applies the MFCA to investigate the material, energetic and economic costs associated with the Italian beef, pork and poultry production, exploring related challenges and opportunities towards the enhancement of the environmental entrepreneurship in the meat sector. The present countryside analysis is based on literature and empirical data collected during the Covid-19 pandemic. It highlights the need to improve knowledge on food waste issue under the economic perspective and its dual impact: when it is generated, in terms of income losses due to by-products and finished products sales failure, and when it is disposed, in terms of disposal costs sustained by farms, processing plants and distribution and sales centers. It is estimated that more than 0.45-0.50 Mt of fresh meat is wasted along the entire Italian agri-food chain, equal to more than 242-268 million euros, to which additional energy and water losses should be added (435-481 million euros). MFCA results are useful for business decisions, highlighting quantities, qualities and costs otherwise not considered in common financial reports.

Material flow cost accounting (MFCA) for the circular economy: An empirical study of the triadic relationship between MFCA, environmental performance, and the economic performance of Japanese companies.

The purpose of this study is to address the question of whether material flow cost accounting (MFCA) can contribute to the circular economy. Because MFCA is an environmental management accounting tool that simultaneously assesses company material and financial flows, it is expected to contribute to the circular economy by assisting companies to achieve both environmental and economic goals through resource efficiency. In short, the expected linkages between MFCA, company environmental and economic goals, and the circular economy are inputs, outputs, and outcomes. However, there is a lack of consensus regarding its potential, perhaps because of the scarcity of studies, with most being models and case studies without readily generalizable results. To address this gap, we analyze the triadic relationship between MFCA, environmental performance, and economic performance using a two-stage regression of data from Japanese listed companies. The main findings are as follows. Companies that implement MFCA more proactively are more likely to improve their environmental performance in terms of energy consumption, CO2 emissions, and waste produced. In turn, those that improve their environmental performance are also more likely to improve their productivity, while those that specifically improve environmental performance in terms of waste produced are also more likely to increase in profitability. Consequently, because MFCA can improve several aspects of environmental performance by saving resources, it can improve productivity by improving a range of environmental performance indicators. In particular, MFCA can improve company productivity and thereby profit, at least by reducing the amount of waste produced. This supports the view that MFCA is an effective tool to contribute to the circular economy.

Research progress and thinking on cost accounting of medical service items based on cost equivalent method / 中华医院管理杂志

Through literature research, this paper analyzed the research progress of medical service project cost accounting based on cost equivalent method. According to the calculation mode of cost equivalent value, this method could be divided into two types, namely, equivalent coefficient method and point method. This paper classified and summarized the application status of cost equivalent method in the cost accounting of medical service projects, analyzed the advantages of cost equivalent method, such as being able to consider a variety of cost drivers, concise accounting process and strong operability, discussed the existing problems of this method, and put forward suggestions for further deepening the application of cost equivalent method and strengthening hospital cost accounting, such as strengthening the summary and case publicity of cost equivalent method, reasonably combining and applying various methods, and scientifically and reasonably developing hospital cost accounting information construction, so as to help build a scientific and accurate cost accounting system for medical service project.

Thoughts and suggestions on high quality cost accounting at multi-campus public hospitals / 中华医院管理杂志

In the era of the new healthcare reform, high-quality cost accounting can effectively enhance the business performance of public hospitals. Compared with single-campus hospitals, the cost accounting of multi-campus hospitals is faced with greater complexity and challenges. The authors analyzed cost accounting problems found in the latter, namely the lack of top-level design in the construction of a fine multi-campus cost accounting system, difficulty of reasonable collection and allocation of various costs, lack of strong information support, outdated research methods used in item cost accounting among others, as well as their causes. On such basis, the authors put forward countermeasures for high-quality cost accounting in multi-campus hospitals, for the purpose of fully leveraging the leadership of cost control in the high-quality development of public hospitals.

How Much Does It Cost for a Surgical ICU Bed in a Public Hospital in India.

INTRODUCTION: Activity-based costing (ABC) is a costing technique that identifies the activities in an organization and assigns the cost to the activities based on the actual resources consumed for each activity. The method was used to ascertain the cost of surgical intensive care unit (SICU) bed in an institute of national importance, such as All India Institute of Medical Sciences (AIIMS), Bhubaneswar, from June 2019 to February 2021. OBJECTIVE: The present study aimed to ascertain the cost of SICU beds per day by the ABC technique. The different elements of cost were analyzed. The cost for selected patients in the SICU unit was calculated by preparing a cost sheet based on the elements of cost and studying the existing charging system. METHODS: A total of 38 cases were selected from the departments of General Surgery, Urology, Orthopedics, and Plastic surgery. Based on the ABC technique, the activity map was developed for SICU (cost center), and the time consumed together with resources for each activity was calculated with respect to human resources, consumables, medicines, and overheads. Thus, the total cost incurred by the hospital for SICU beds per day was estimated using the cost sheet analysis. RESULTS: The cost was calculated to be Rs. 11,241/- per day (155 USD) against the hospital charge of Rs. 35/- (<0.5 USD) for general patients and Rs. 1000/- for private ward patients. Exchange Conversion Rate used is 1 USD = 72.60 INR (2020-21). CONCLUSION: The public sector hospitals in India provide health-care services for free and at a subsidized rate; hence, ascertaining the cost incurred by the hospital is necessary for policy decisions.

From centralized DRG costing to decentralized TDABC-assessing the feasibility of hospital cost accounting for decision-making in Denmark.

BACKGROUND: The objective is to examine hospital cost accounts to understand the foundation upon which healthcare decisions are based. More specifically, the aim is to add insights to accounting practices and their applicability towards a newly establish value-based agenda with a focus on patient-level cost data. METHODS: We apply a cost accounting framework developed to position and understand hospital cost practices in relation to government requirements. Allocated cost account data from 2015 from all Danish hospitals were collected and analyzed. These cost accounts lay the foundation for diagnosis related group (DRG) rate setting. We further compare the data's limitations and potential in a value-based healthcare (VBHC) agenda with the aim of implementing time-driven activity based costing (TDABC). RESULTS: We find exceedingly aggregated department-level data that are not tied to patient information. We investigate these data and find large data skewness in the current system, mainly due to structural variances within hospitals. We further demonstrate the current costs data's lack of suitability for VBHC but with suggestions of how cost data can become applicable for such an approach, which will increase cost data transparency and, thus, provide a better foundation for both local and national decision-making. CONCLUSIONS: The findings raise concerns about the cost accounts' ability to provide valid information in healthcare decision-making due to a lack of transparency and obvious variances that distort budgets and production-value estimates. The standardization of costs stemming from hospitals with large organizational differences has significant implications on the fairness of resource allocation and decision-making at large. Thus, for hospitals to become more cost efficient, a substantially more detailed clinically bottom-led cost account system is essential to provide better information for prioritization in health.

Preliminary Examination of an Appropriate Price Calculation Method and Medical Treatment Costs for Foreign Visitors in Japan.

This study proposes a method for calculating the appropriate medical treatment price level for foreign visitors (FVs) in Japan. Hospital management costs and foreign prices were analyzed from a market principles perspective to determine the medical treatment price. The study involved two stages: a preliminary survey and an extended survey, supplemented by an international survey. Relatively frequent diseases were selected, and the costs incurred by hospitals for the treatment of FVs were analyzed though data from three hospitals, covering 24 outpatients and 4 inpatients. Payments made by three insurance companies for overseas medical institution services for Japanese tourists with pharyngitis were analyzed. This study shows that the appropriate medical treatment prices for FVs, considering profits, were 1.22-4.26 times higher compared with prices under Japan's public health insurance plans. Furthermore, these prices were 1.31-4.26 times higher for outpatients with pharyngitis and external injury and 1.22-3.66 times higher for inpatients with appendicitis and femoral fractures. The price of pharyngitis treatment in 12 countries was USD 20.32-158.75 per patient for Japanese tourists, whereas FVs paid 60.24 dollars (1.13 times higher than Japan's public healthcare price) in Japan. This study shows it was appropriate to set the ideal price level for FVs higher than that for Japanese patients.

Review on pollution damage costs accounting.

Although the concept of damage cost accounting is already well-studied and applied, its application to pollution still lacks of an integrated accounting framework, while the spatial-temporal variability of accounting results has not been fully discussed. To fill this gap, this review frames the existing models and their limitations into static and dynamic categories, outlining the characteristics of different methods, which consider both human and non-human damages caused by pollution. Existing data sources, that could be used for accounting purposes, are detailed. Finally, this work discusses the relevance of spatial scales for the computation process, in order to obtain a more detailed information support for environmental policies for future compensatory actions. Conclusions highlights the need to develop a more comprehensive database of exposure-response relationships and to incorporate system alternatives into models to achieve a more accurate damage assessment.

Data, data flows, and model specifications for linking multi-level contribution margin accounting with multi-level fixed-charge problems.

This article describes the data, data flows, and spreadsheet implementations for linking multi-level contribution margin accounting as a subsystem in cost accounting with several versions of a multi-level fixed-charge problem (MLFCP), the latter based on the optimization approach in operations research. This linkage can reveal previously hidden optimization potentials within the framework of multi-level contribution margin accounting, thus providing better information for decision making in companies and other organizations. For the data, plausible fictitious values have been assumed taking into consideration the calculation principles in cost accounting where applicable. They include resource-related data, market-related data, and data from cost accounting needed to analyze the profitability of a company´s products and organizational entities in the presence of hierarchically structured fixed costs. The data are processed and analyzed by means of mathematical optimization techniques and sensitivity analysis. The linkage between multi-level contribution margin accounting and MLFCP is implemented in three spreadsheet files, including versions for deterministic optimization, stochastic optimization, and robust optimization. This paper provides specifications for compatible solver add-ins and for executing sensitivity analysis. The data and spreadsheet implementations described in this article were used in a research article entitled "Making better decisions by applying mathematical optimization to cost accounting: An advanced approach to multi-level contribution margin accounting" [1]. The data sets and the spreadsheet implementations may be reused a) by researchers in management and cost accounting as well as in operations research and quantitative methods for verification and for further development of the linkage concept and of the underlying optimization models; b) by practitioners for gaining insight into the data requirements, methods, and benefits of the proposed linkage, thus supporting continuing education; and c) by instructors in academia who may find the data and spreadsheets valuable for classroom use in advanced courses. The complete spreadsheet implementations in the form of three ready-to-use Excel files (deterministic, stochastic, and robust version) are available for download at Mendeley Data. They may serve as customizable templates for various use cases in research, practice, and education.

True cost of surgical aortic valve replacement and implications for price setting and diagnosis-related groups: evidence from a tertiary hospital in Eastern China.

Background: Surgical aortic valve replacement (SAVR) has long been the standard treatment for patients with severe aortic stenosis in China, but the costs of SAVR from a hospital perspective in China have not been thoroughly researched. Currently, diagnosis-related groups in China are based on historical expenses that are closely related to the unit charges set by the official pricing department and are frequently inaccurate compared with actual resource consumption. Materials & methods: Through a retrospective empirical study on the costs and charges of SAVR cases in a tertiary hospital, this study aimed to compare the costs and charges of service items. We collected clinical information from patients undergoing SAVR (isolated or concomitant procedures) and financial information from the hospital in 2015 and 2016. Top-down full cost accounting and step-allocation were the main methods used in this study. Result: This research selected 203 SAVR cases in 2015 and 214 cases in 2016. The median length of hospital stay was 15.92 days (6.07 days pre surgery and 9.57 days post surgery). The average human resource cost of care per day per bed in the cardiovascular surgery department, including doctors and nurses, was US $62.22 in 2015 and $66.17 in 2016, but the corresponding charge was no more than $24. For operation, the cost of isolated SAVR was $665 in 2015 and $1015 in 2016, while the charge was $820. For anesthesiology, the cost of isolated SAVR was $400 in 2015 and $526 in 2016, while the average charge was $192. For examination service items, some costs did not exceed charges. The average total cost of a case was $19,299 ± 8954, while the average total charge was $18,923 ± 9194. Conclusion: SAVR is associated with significant resource utilization and hospital stay duration. The fees for human resources and services associated with SAVR do not reflect the true costs of SAVR in a Chinese hospital setting. This study may assist in future budget planning and price setting for policy makers in China.

The Cost of Hip and Knee Revision Arthroplasty by Diagnosis-Related Groups: Comparing Time-Driven Activity-Based Costing and Traditional Accounting.

BACKGROUND: Traditional hospital cost accounting (TA) has innate disadvantages that limit the ability to meaningfully measure care pathways and quality improvement. Time-driven activity-based costing (TDABC) allows a meticulous account of costs in primary total joint arthroplasty (TJA). However, differences between TA and TDABC have not been examined in revision hip and knee TJA (rTJA). We aimed to compare total costs of rTJA by the diagnosis-related group (DRG), measured by TDABC vs TA. METHODS: Overall costs were calculated for rTJA care cycles by DRG for 2 years of financial data (2018-2019) at our single-specialty orthopedic institution using TA and TDABC. Costs derived from TDABC, based on time and resources used, were compared with costs derived from TA based on historical costs. Proportions of implant and nonimplant costs were measured to total TA costs. RESULTS: Seven hundred ninety-three rTJAs were included in this study, with TA methodology resulting in higher cost estimates. The total cost per DRG 468, rTJA with no comorbidities or complications (CC), DRG 467, rTJA with CC, and DRG 466, rTJA with major CC, estimated by TDABC was 69%, 67%, and 49% of the estimation by TA, respectively. Implant and nonimplant costs represented different proportions between methodologies. CONCLUSION: Considerable differences exist, as TA estimations were 31%-51% higher than TDABC. The true cost is likely a value between the estimations, but TDABC presents granular and patient-specific cost data. TDABC for rTJA provides valuable bottom-up information on cost centers in the care pathway and, with targeted interventions, may lead to a more optimal delivery of value-based health care.

Making better decisions by applying mathematical optimization to cost accounting: An advanced approach to multi-level contribution margin accounting.

The purpose of multi-level contribution margin accounting in cost accounting is to analyze the profitability of products and organizational entities with appropriate allocation of fixed costs and to provide relevant information for short-term, medium- and longer-term decisions. However, the conventional framework of multi-level contribution margin accounting does not usually incorporate a mathematical optimization method that simultaneously integrates variable and fixed costs to determine the best possible product mix within hierarchically structured organizations. This may be surprising in that operations research provides an optimization model in the form of the fixed-charge problem (FCP) that takes into account not only variable costs but also fixed costs of the activities to be planned. This paper links the two approaches by expanding the FCP to a multi-level fixed-charge problem (MLFCP), which maps the hierarchical decomposition of fixed costs in accordance with multi-level contribution margin accounting. In this way, previously hidden optimization potentials can be made visible within the framework of multi-level contribution margin accounting. Applying the linkage to a case study illustrates that the original assessment of profitability gained on the sole basis of a multi-level contribution margin calculation might turn out to be inappropriate or even inverted as soon as mathematical optimization is utilized: products, divisions, and other reference objects for fixed cost allocation, which at first glance seem to be profitable (or unprofitable) might be revealed as actually unprofitable (or profitable), when the multi-level contribution margin calculation is linked to the MLFCP. Furthermore, the proposed concept facilitates assessment of the costs of an increasing variant diversity, which also demonstrates that common rules on how to interpret a multi-level contribution margin calculation may have to be revised in some cases from the viewpoint of optimization. Finally, the impact of changes in the fixed cost structure and other parameters is tested via sensitivity analyses and stochastic optimization.

Approaches for estimating benefits and costs of interventions in plant biosecurity across invasion phases.

Nonnative plant pests cause billions of dollars in damages. It is critical to prevent or reduce these losses by intervening at various stages of the invasion process, including pathway risk management (to prevent pest arrival), surveillance and eradication (to counter establishment), and management of established pests (to limit damages). Quantifying benefits and costs of these interventions is important to justify and prioritize investments and to inform biosecurity policy. However, approaches for these estimations differ in (1) the assumed relationship between supply, demand, and prices, and (2) the ability to assess different types of direct and indirect costs at invasion stages, for a given arrival or establishment probability. Here we review economic approaches available to estimate benefits and costs of biosecurity interventions to inform the appropriate selection of approaches. In doing so, we complement previous studies and reviews on estimates of damages from invasive species by considering the influence of economic and methodological assumptions. Cost accounting is suitable for rapid decisions, specific impacts, and simple methodological assumptions but fails to account for feedbacks, such as market adjustments, and may overestimate long-term economic impacts. Partial equilibrium models consider changes in consumer and producer surplus due to pest impacts or interventions and can account for feedbacks in affected sectors but require specialized economic models, comprehensive data sets, and estimates of commodity supply and demand curves. More intensive computable general equilibrium models can account for feedbacks across entire economies, including capital and labor, and linkages among these. The two major considerations in choosing an approach are (1) the goals of the analysis (e.g., consideration of a single pest or intervention with a limited range of impacts vs. multiple interventions, pests or sectors), and (2) the resources available for analysis such as knowledge, budget and time.

Identifying surgeon and institutional drivers of cost in total shoulder arthroplasty: a multicenter study.

BACKGROUND: Despite rapid increases in the demand for total shoulder arthroplasty, data describing cost trends are scarce. We aim to (1) describe variation in the cost of shoulder arthroplasty performed by different surgeons at multiple hospitals and (2) determine the driving factors of such variation. METHODS: A standardized, highly accurate cost accounting method, time-driven activity-based costing, was used to determine the cost of 1571 shoulder arthroplasties performed by 12 surgeons at 4 high-volume institutions between 2016 and 2018. Costs were broken down into supply costs (including implant price and consumables) and personnel costs, including physician fees. Cost parameters were compared with total cost for surgical episodes and case volume. RESULTS: Across 4 institutions and 12 surgeons, surgeon volume and hospital volume did not correlate with episode-of-care cost. Average cost per case of each institution varied by factors of 1.6 (P = .47) and 1.7 (P = .06) for anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA), respectively. Implant (56% and 62%, respectively) and personnel costs from check-in through the operating room (21% and 17%, respectively) represented the highest percentages of cost and highly correlated with the cost of the episode of care for TSA and RSA. CONCLUSIONS: Variation in episode-of-care total costs for both TSA and RSA had no association with hospital or surgeon case volume at 4 high-volume institutions but was driven primarily by variation in implant and personnel costs through the operating room. This analysis does not address medium- or long-term costs.