- Titel
- A user-oriented Target Costing instrument for primary healthcare services cost management for the Brazilian Unified Health System
- Zitierfähige Url:
- https://nbn-resolving.org/urn:nbn:de:bsz:ch1-qucosa2-840564
- Datum der Einreichung
- 07.12.2022
- Datum der Verteidigung
- 07.02.2023
- Abstract (EN)
- The Brazilian Unified Health System (UHS) primary care services are provided by several structures scattered over more than five thousand municipalities. The Primary Care Units (PCU) are the most common structures, and are the basis of the system providing a large volume of services to most Brazilian populations. The operational management is under the responsibility of the municipalities, while the funding, policies, and strategic management are shared with the Union and the municipality’s state. In this context, municipal managers usually face several challenges in understanding the local population’s needs, managing service quality and users’ satisfaction, determining and managing service costs, and measuring service performance. As a rule, managers do not have advanced management tools, and the planning of services and service costs is carried out through annual plans and actions that define how many services should be provided and the total amount of funds to cost these services. When annual planning starts, most costs are already committed, because most of them are fixed and difficult to influence after starting the service delivery. For more efficient cost management, it would be appropriate to influence PCU costs during the planning phase, before starting the service delivery. In order to contribute to primary healthcare services management, this study aimed to develop a user-oriented Target Costing instrument for cost management of primary care services in the UHS. Target Costing is best known in the industry, and its use in healthcare and public services can still be considered incipient. In typical market situations, Target Costing derives the target cost by subtracting the target profit from the target price. However, public primary healthcare services are free of charge and do not have selling prices. Furthermore, Brazilian public accounting does not measure the financial results through profit or loss. The literature presents Economic Management (EM) as a way to overcome this challenge. The EM concepts are suitable for measuring the result when sale prices are unavailable or commercialised. EM includes the concepts of “opportunity revenue” replacing the sales prices and revenues, and “economic result” replacing profit or loss. Using these two concepts allows the implementation of phases 3 and 4 of the Target Costing process, similarly to the traditional way. The instrument integrates the Servqual and the Kano Model in regard to hearing the voice of the users. Servqual has been frequently applied to collect data on expectations and perceptions of quality from the users of health services. Both tools enable the development of indicators that represent the importance attributed to quality items in the quality gap, customer satisfaction index, and the Kano categories. Another relevant point to the Target Costing instrument is the connection of the user’s given importance to quality requirements and the service characteristics, processes, and the employed resources and employee groups. This connection is developed by deploying quality requirements using the Quality Function Deployment (QFD) process. QFD also supports the new service and new PCU design process. The instrument also integrates the Time-Driven Activity-Based Costing (TDABC), which assumes a relevant role in organising the cost accounting and supports the design activities. Simulating the instrument’s application to a fictitious case shows a suitable cost management approach in the planning and design phases of the new PCUs, respecting the main Target Costing fundamentals and achieving the primary objective of this study.
- Freie Schlagwörter (EN)
- primary healthcare services, patient orientation, market orientation, cost management, cost planning, Unified Health System, Target Costing, Quality Function Deployment, Servqual, Kano Model, Time-Driven Activity-Based Costing
- Klassifikation (DDC)
- 650
- Normschlagwörter (GND)
- Zielkostenrechnung, Kostenrechnung, Gesundheitswesen
- GutachterIn
- Prof. Dr. Prof. h. c. Uwe Götze
- Prof. Dr. Paulo Miguel Nogueira Peças
- BetreuerIn Hochschule / Universität
- Prof. Dr. Prof. h. c. Uwe Götze
- Den akademischen Grad verleihende / prüfende Institution
- Technische Universität Chemnitz, Chemnitz
- Version / Begutachtungsstatus
- publizierte Version / Verlagsversion
- URN Qucosa
- urn:nbn:de:bsz:ch1-qucosa2-840564
- Veröffentlichungsdatum Qucosa
- 13.03.2023
- Dokumenttyp
- Dissertation
- Sprache des Dokumentes
- Englisch
- Lizenz / Rechtehinweis
- Inhaltsverzeichnis
LIST OF FIGURES XI LIST OF TABLES XII ABREVIATIONS XIV 1 INTRODUCTION 1 1.1 PROBLEM AND OBJECTIVES SETTING 1 1.2 METHODOLOGICAL PROCEDURES 7 1.3 OUTLINE 8 2 THE UNIFIED HEALTHCARE SYSTEM 10 2.1 AN OVERVIEW OF THE HEALTHCARE MARKET 11 2.1.1 Characteristics of services 11 2.1.2 Commonly applied market concepts 12 2.1.3 Healthcare market influencing factors 14 2.1.4 Imperfections of the healthcare market 18 2.1.5 Strategies to reduce health systems costs 20 2.2 THE BRAZILIAN HEALTHCARE INDUSTRY 22 2.2.1 A brief history of the Brazilian healthcare industry 22 2.2.2 The structure of the Brazilian healthcare system 25 2.3 THE UNIFIED HEALTH SYSTEM – THE PILLAR OF FREE AND PUBLIC SERVICES 27 2.3.1 Guiding concepts 27 2.3.2 The organisation of the system 28 2.3.3 The development of the services delivery 31 2.3.4 The Primary Care Unit 33 2.4 THE ARRANGEMENT OF PUBLIC FINANCES 35 2.4.1 Funding 35 2.4.2 Public budget 37 2.4.2.1 The legal structure of the Brazilian public budget 37 2.4.2.2 Accounting aspects 38 2.4.2.3 Revenues and expenditures 41 2.4.3 Cost management 42 2.4.4 The services planning process 45 3 COST ACCOUNTING AND MANAGEMENT 47 3.1 THEORETICAL BASIS OF COST ACCOUNTING AND MANAGEMENT 47 3.1.1 Fundamental concepts 47 3.1.2 Principles of cost assignment 51 3.2 COST ACCOUNTING 52 3.2.1 Cost-type accounting 52 3.2.1.1 Overview of cost types 52 3.2.1.2 Material costs 53 3.2.1.3 Labour costs 54 3.2.1.4 Depreciation costs 56 3.2.1.5 Other cost types 57 3.2.2 Cost centre accounting 58 3.2.2.1 Tasks of cost centre accounting 58 3.2.2.2 Process of cost centre accounting in the full absorption system 60 3.2.3 Costing systems 61 3.2.3.1 Direct Costing 61 3.2.3.2 Activity-Based Costing 63 3.2.3.3 Time-Driven Activity-Based Costing 67 3.3 COST MANAGEMENT 69 3.3.1 Features, tasks, and instruments 69 3.3.2 Target Costing 75 3.3.2.1 Origins and overview 75 3.3.2.2 Fundamentals 77 3.3.2.3 The organisation of the process 82 3.3.2.4 The first phase – Development of an initial product concept 84 3.3.2.5 Second phase – Determination of product target costs 87 3.3.2.6 The third phase – splitting, estimating, and attaining the target costs in the development and construction stage 91 3.3.2.7 The fourth phase – Target costs attainment and improvement in the market cycle 98 3.3.3 Quality management tools 99 3.3.3.1 Service Quality Model 100 3.3.3.2 Kano Model 104 3.3.3.2.1 Origins and fundamentals 104 3.3.3.2.2 Construction and administration of the Kano instrument 108 3.3.3.2.3 Integrating the Servqual and the Kano instruments 113 3.3.3.3 Quality Function Deployment 115 3.3.3.3.1 Origins and fundamentals 115 3.3.3.3.2 Steps of the QFD process 120 4 A TARGET COSTING INSTRUMENT FOR UHS PRIMARY CARE SERVICES 127 4.1 PILLARS OF THE INSTRUMENT 127 4.1.1 Integrative Target Costing approach 127 4.1.2 Determining the target price 133 4.1.3 Employing the Servqual and the Kano Model 136 4.1.4 Using the QFD houses to deploy the desired quality 141 4.1.5 Using the TDABC as the instrument costing system 147 4.2 SPECIFYING AND APPLYING THE INSTRUMENT 152 4.2.1 Developing the initial concept of services 152 4.2.2 Applying the Servqual and Kano Model questionnaires 155 4.2.3 Determining target prices and allowable costs applying EM 162 4.2.4 The House of Quality Features Design 166 4.2.4.1 Preparing the quality requirements’ weights and additional information 166 4.2.4.2 Developing the quality features 169 4.2.4.3 Correlating quality requirements and quality features 173 4.2.4.4 Determining additional information of quality features 176 4.2.4.5 Final assessment of the first house and referral to the next house 179 4.2.5 Developing the House of Service Design 182 4.2.5.1 Designing services and processes 182 4.2.5.2 Correlating quality features and processes 185 4.2.6 The House of Resource and Employee Groups Design 188 4.2.6.1 Developing the resource and employee groups 188 4.2.6.2 Correlating processes and resource groups 190 4.2.7 Target cost splitting, estimation and attainment 193 4.2.7.1 Developing the TDABC time equations 193 4.2.7.2 Target cost splitting 197 4.2.7.3 Target costs estimation and attainment 200 4.2.7.3.1 Determining the practical capacity supplied 200 4.2.7.3.2 Estimating the first drifting costs 206 4.2.7.3.2.1 Cost type accounting 206 4.2.7.3.2.2 Cost centre accounting 211 4.2.7.3.2.3 Cost object accounting – the service units costs 213 4.2.7.3.3 Determining the cost gaps 215 4.2.8 Cost reduction phase 221 4.2.8.1 Perform value engineering 221 4.2.8.1.1 Identifying items for cost reduction 222 4.2.8.1.2 Developing ideas for cost reduction 231 4.2.8.2 Specifying target costs 235 4.2.9 Attainment and improvement of target costs in service delivery phase 235 5 FINAL CONSIDERATIONS 238 5.1 SUMMARY AND RESEARCH PROGRESS 238 5.2 RESEARCH LIMITATIONS AND FUTURE RESEARCH OPPORTUNITIES 241 REFERENCES 242 APPENDIX I –REVIEW OF LITERATURE - SERVQUAL 293 APPENDIX II – SERVICE DEMAND ESTIMATES 297 APPENDIX III – RESOURCE GROUPS UNIT ALLOWABLE COSTS 299 APPENDIX IV – BUILDING CONSTRUCTION COSTS 301 APPENDIX V – ADDITIONAL INFORMATION ABOUT COST DISTRIBUTION 302 APPENDIX VI – SERVICES COST GAP 303 APPENDIX VII – SERVICES COST GAP WITHOUT THE ADMINISTRATION PROCESS COSTS 305