Health economics is a branch of economics concerned with the formal comparison of costs and consequences of health care. One of the seminal papers in this field was written by Neuhauser and Lweicki, who in 1975 applied a rule of diminishing returns to predict that the cost per cancer death prevented by the sixth in a series of six repeated fecal occult blood tests exceeded one million dollars.
Since about 10 years health economics integrates the wider domain of strategic health management.
This dimension declines through the concepts of mastery of the depenses of health and management of the quality, It is about a step of systematization of procedures integrating at the same moment the problem of the profit of the patient, the motivation of the staff and the reduction of costs.
Solutions of strategic health management
Appeared on the world market recently, these solutions allow to calculate and to transform the costs of dysfunctions that the centre of health usually undergoes, and the distances from earnings reports, in a force, an immense asset strengthening its efficiency.
Also known under the name of " Business Workflow Analysis " (BWA) the software packages of strategic management supply in a working team, (a company, a public administration or a hospital complex) with tools of help in the piloting of the chain of internal value, to estimate the own progress, to control its functioning and its dysfunctions, to settle tensions between its members and the other groups of the environment. By these tools the study group controls itself, is reflected and controls itself in least costs and for the best possible result.
Three levels of strategic control of health depenses A system of strategy is generally divided into four levels of control of piloting of the chain of internal value -Software packages of control of the global management of the functions of the centre of health -Software packages of global strategic regulation of costs - performances in real time -Software packages specialized of the extension of particular functions ABC-ABM
Software packages of control of the global management of the functions of the centre of health. They are tools: -Of diagnosis and quantification of the indicators of piloting and the recoverable potential -Of organization and strategic economic planning with consideration of the system of pay and motivation (premiums of objective, profit-sharing, salaries in the merit) -Of evaluation and reporting of accounting results
Software packages of global strategic regulation of costs - performances They are the software packages of mastery in real time of the costs of regulation 5 generative basic dysfunctions of outlays and the distances from accounts of management: -Master costs of absenteeism -Master costs of occupational accidents -Master costs of qualitative defect -Master costs of relative direct distances from productivity in the time of hand of work and consumption materials -Mastery of the costs of rotation and forming (training) of the staff
Software packages specialized of the extension of particular functions ABC-ABM They are software packages -Of strategic management of human resources -Of strategic management of the productivity -Of strategic management of the logistics / supply chain -Of strategic management of knowledge, memory of the company, -Of strategic management of the quality / Industry - Business - services; -Of strategic management of the quality / Health
Tools automated by management of the quality in the establishments of health They are consisted generally by two types of modules: •Files of transfer of the data of results of performance quality from software 4 to software 10 -Synthesis of the strategic actions of improvement of the structures of the company -Synthesis of the strategic actions of the social by composing performance -Synthesis of social performances and economic performances of mastery of the reducing dysfunctions of the value for the external customer and for the internal customer
Repository modules of controllable actions of quality on site where at distance: -Modulate rights and information of the patient (RIP) -Modulate file of the patient (FP) -Modulate organization of the coverage of the patient (OCP) -Modulate management of the establishment and the sectors (MES) -Modulate management of human resources (MHR) -Modulate management of logistic functions (MLF) -Modulate management of the system of information (MSI) -Modulates sanitary attentiveness of blood transfusion safety (SABT) -Modulates surveillance, prevention and control of the infectious risk (SPCI)
Treatment of the difficulties of implementation of tools The biggest obstacle in the application of the solutions of strategic management is to convince the frame and the staff of the utility of these tools.
Consensus is generally obtained on one hand by the initial diagnosis of the recoverable potential. •The importance of the recoverable potential reserve by the reduction of costs hidden from dysfunctions arouses first of all interest and membership of the staffs centre responsible for the management and for the balance of the centre of health . -As information the average costs of dysfunctions by sector with regard to their salary mass are 109 % in the industry, 43 % in insurances and banks, 48 % in hospital complexes, 65 % in the administration and the local governments. -The rate of recovery of the diagnosed potential is 85 %.
• The system of motivation based on the distribution of the potential to be got back between the company and its employees arouses generally interest and membership of the staff of execution.
•The staff of frame and the users receives besides a training strengthening the mastery of tools and the corporate culture in strategic management.
Example of system network p2p of strategic management
‘’Oberon BWA " (Business Workflow Analysis). MedLine reference for Neuhauser and Lweicki's paper