병원관리학 개론: 병원관리지표

2010년 5월 31일건양의대 예방의학교실

이진용

강의순서

병원 관리지표의 예

어떤 지표를 사용해야 하는가? Balanced Score Card Financial indicators

생각해 봅시다

대형병원장이라면?중소형병원장이라면?공공병원장이라면?건강보험공단 이사장이라면?보건복지부 관료라면?위에 열거한 이들이 모두 같은 병원관리지표를 사용할까요?

만일 영리법인이 허용된다면 이들이중시하는 병원관리지표는 무엇일까요?

Carolina Healthcare System 개요 CHS is the largest health care system in the Southeast as well as th

e third largest public, multi-hospital system in the nation.

CHS owns, leases or manages 25 hospitals, 8 nursing homes, imaging facilities, ambulatory surgery centers and other health care services with combined net operating revenue in excess of $4.7 billion.

CHS has a comprehensive network of physicians, including over 1,200 employed physicians and more than 200 residents delivering care in over 280 sites in the Carolinas.

CHS has been AA-rated by both Moody’s and Standard & Poor's since 1983 (confirmed August, 2008).

CHS is recognized nationally for its quality of care and patient service levels.

CHS operates one of only five academic medical centers in the state of North Carolina.

Columbus Regional Healthcare System: Key Performance Indicators

Carolina Healthcare System에 소속된 한지역을 담당하고 있는 Healthcare System

CRHS의 주요 병원관리 지표

Key Volume Indicators

Key Operating Indicators

Key Financial Metrics

Service and Quality

CRHS

1. Key volume indicators Inpatient Acute Discharges Adjusted Discharges Deliveries Observation Days Inpatient Surgeries Outpatient Surgeries Endoscopy Volume Outpatient Visits Emergency Department Visits

2. Key operating indicators Average Daily Census Average Length of Stay Overall Case Mix Index Average Daily Census for Observations Inpatient Charges to Total Charges Ratio Hospital FTE’s Hospital FTE’s per Adj. Occupied Bed Salaries, Wages, Benefits % Net Operating

Revenue Payor Mix Bad Debt & Charity % Net Operating Revenue

3. Key financial metrics

Operating Margin Operating Cash Flow Margin Days of Cash Capital Expenditures

4. Service and Quality Service satisfaction rates among

departments or organizations Quality of care◦ Hospital acquired conditions◦ MRSA infection rate◦ Patients with 100% of Medications Reconciled at

Discharge◦ Inpatient Mortality Rate◦ Appropriate Care Score◦ Length of Stay◦ ED Patients Left Without MD Treatment

High Performance Organizations

Source: Kaufman Hall, Achieving Growth and Scale, March 2008 ACHE Conference.

Growth in Patient Volume and Profitability

Increased Access to Capital

Investment in New Technologies, Infrastructure

and Work Force

Improved Physician and Patient SatisfactionScale

Balanced Score Card (BSC)의 정의 In simple terms, they are displays of key

indicators of an organization’s performance in a concise, easy-to interpret format.

Dash Board=BSC=Instrumental Panel 위의 용어들은 거의 같은 의미로 쓰임 David P. Norton and Robert Kaplan이 처음으로 “balanced scorecard” 라는 용어를 그들의 저서 “The Strategy-Focused Organization: How Balanced Scorecard Companies Thrive in the New Business Environment”에서 사용하였음

BSC의 예

소결

병원관리지표는 무수히 많기 때문에조직이 목표로 하는 성과(performance)가 무엇이냐에 따라 주요 관리지표를선정하게 됨

게다가 국가보건의료체계에서는 각 참여자의 입장에 따라 선호하거나 중요시하는 병원관리지표가 다를 수 있음을 유념해야 함

Financial indicators

다른 지표에 비해 상대적으로 우리나라에서 제대로 사용하지 못하고 있음

주요 재무 재표를 이용한 financial indicator를 소개하도록 하겠음◦ Balanced sheet◦ Income statement◦ Cash flow

이외에 주로 쓰이는 operating analysis method도 더불어 소개할 것임

Balance Sheet: Assets

Balance Sheet: Liabilities and Equity

Income Statement

Statement of Cash FlowsCash Flows from Operating Activities:

Change in net assets (net income) $ 8,572Adjustments:Depreciation 4,130Increase in accounts receivable (1,102)Increase in inventories (195)Decrease in accounts payable (438)Increase in accrued expenses 229Net cash flow from operations $11,196

Cash Flows from Investing Activities:Investment in plant and equipment ($ 4,293)

Statement of Cash Flow (Cont.)Cash Flows from Financing Activities:

Investment in short-term securities ($ 2,000)Repayment of LT debt (2,150)Repayment of notes payable (3,412)Capital lease principal repayment (323)Change in current portion of LT debt 150Net cash flow from financing ($ 7,735)

Net increase (decrease) in cash ($ 832)

Beginning cash and equivalents $ 5,095

Ending cash and securities $ 4,263

Financial Ratio Analysis Categories

Profitability: Is the business generating sufficient profits?

Liquidity: Can the business meet its cash obligations as they become due?

Debt management: Does the business use the right mix of debt and equity?

Asset management: Does the business have the right amount of assets for the volume of services it provides?

어떻게 이 지표들을 해석하는가?

A single ratio value has little meaning. For example, a total margin of 7.0%.

Therefore, two techniques are used to help interpret “the numbers”:◦ Trend (time series) analysis◦ Comparative (cross-sectional) analysis

Both techniques will be illustrated in the examples to follow.

Profitability Ratios (2006)

Liquidity Ratios (2006)

Debt Management Ratios (2006)

Times Interest Earned

Asset Management Ratios (2006)

Days sales outstanding

단일 지표는 없을까? Du Pont analysis◦ TM: expense control◦ TA turn over: asset utilization◦ Equity multiplier: debt utilization

Operating Indicator Analysis

Net Price Per Discharge (2006)

Occupancy Percentage (Rate)

제한점

이들 Ratio가 병원의 재정 상황을 정확히 반영하지 못하는 경우도 있기 때문에 해석에 매우 신중을 기해야 함◦ Different accounting conventions◦ Seasonal factors◦ Inflation◦ Window dressing

Financial Ratio가 좋은 것이 늘 병원 또는 사회전체를 위해 좋은 것인가라는가치의 문제가 될 수도 있음

서울대 병원 재정지표 소개 및 제한점

엑셀 파일 참조

재무재표가 너무 간략히 나와 앞서 설명한 재정지표를 산출하기가 매우 어려움

병원관리학 개론: 병원관리지표강의순서생각해 봅시다Carolina Healthcare System 개요Columbus Regional Healthcare System: Key Performance IndicatorsCRHS의 주요 병원관리 지표1. Key volume indicators2. Key operating indicators3. Key financial metrics4. Service and Quality슬라이드 번호 11Balanced Score Card (BSC)의 정의BSC의 예슬라이드 번호 14슬라이드 번호 15슬라이드 번호 16소결Financial indicatorsBalance Sheet: AssetsBalance Sheet: Liabilities and Equity Income StatementStatement of Cash FlowsStatement of Cash Flow (Cont.)Financial Ratio Analysis Categories어떻게 이 지표들을 해석하는가?Profitability Ratios (2006)슬라이드 번호 27Liquidity Ratios (2006)Debt Management Ratios (2006)Asset Management Ratios (2006)슬라이드 번호 31단일 지표는 없을까?Operating Indicator Analysis제한점서울대 병원 재정지표 소개 및 제한점