What about non-medical expenses? Costs of a medical organization: an economist's memo

Classification of the costs of military medical institutions in the provision of paid medical services

O.F. Kuzmich,

cand. economy Sciences, Associate Professor of the Department accounting, economic analysis and property valuation, State Academy for Advanced Studies and Retraining of Personnel for Construction and Housing and Communal Complex (129329, Russia, Moscow, Igarsky proezd, 2; e-mail: [email protected])

I.V. Ryzhov,

Doctor of Economics Sciences, Professor, Professor of the Department of Management and Marketing, State Academy advanced training and retraining of personnel for construction and housing and communal services (129329, Russia, Moscow, Igarsky proezd, 2; e-mail: [email protected])

Annotation. The article presents the calculation of costs for paid medical services of military medical institutions, which makes it possible to correctly allocate costs and include them in the cost of medical services provided. On this basis, a nomenclature of cost items in military medical institutions is proposed.

abstract. The article presents the calculation of the cost of paid medical services of the military medical institutions, allowing proper distribution of expenses and their inclusion in the cost of medical services. On this basis it is proposed nomenclature calculation of the expenditure at the military medical institutions.

Key words: medical services, costs, costs, calculation, prime cost.

Keywords: health services, costs, expenses, cost estimate, cost price.

To improve the practice of calculating the cost of medical services and accounting for the costs of their provision, analysis of the composition of costs and their classification are of great importance. The solution of this problem presupposes an economically justified grouping and characterization of costs and the creation of conditions for the correct distribution of costs and their inclusion in the cost of medical services provided by military medical institutions.

In the theory and practice of accounting, costs are divided into main and overhead, direct and indirect, costs of the current (reporting) month and future periods, simple (element-by-element) and complex (complex), production and non-production, etc. In the current accounting methodology, cost grouping is based on the following features: economic role in the production process, according to the method of inclusion in the cost price, in relation to the reporting period, but uniformity and reflection in the calculation, according to the area of ​​​​occurrence.

Accounting in public sector organizations is currently regulated by a number of regulatory legal acts, the main of which include:

Budget Code of the Russian Federation;

Federal Law No. 402-FZ of 06.12.2011 “On Accounting”;

- "Instructions for the application of the Unified Chart of Accounts...", approved by order of the Ministry of Finance of Russia dated 01.12.2010 No. 157n, hereinafter - Instruction No. 157n (applied by all public sector organizations, including state (municipal) institutions of all types).

Based on the Unified Chart of Accounts and Instruction No. 157n, accounting entities (public sector organizations) apply the relevant Charts of Accounts and Instructions for

their application (table 1).

As a grouping of transactions carried out in the sector government controlled, depending on their economic content is the classification of operations of the public administration sector.

The classification of general government transactions consists of the following groups:

100 "Income";

200 "Expenses";

300 “Receipt of non-financial assets

400 "Disposal of non-financial assets";

500 “Receipt of financial assets

600 "Disposal of financial assets";

700 "Increase in liabilities"; one

800 "Reduction of liabilities"1.

Group 100 "Income" includes, in particular, article 130 "Income from the provision of paid services(works)”, which includes income from the provision of paid services (works) and compensation of costs, including:

Income from the provision of paid services (works);

Compensation of state expenses;

Compensation of expenses of state (municipal) institutions;

Income from reimbursement of expenses incurred in connection with the operation of state (municipal) property, secured on the right of operational management;

Reimbursement of expenses for enforcement actions by bailiffs;

Hostel use fee;

Income from the provision of medical services, the subject of mandatory health insurance;

provided to insured persons in the system

Table 1

Subjects of accounting and acts that approved the Chart of Accounts and Instructions for its application

Subject of accounting Act that approved the Chart of Accounts and Instructions for its application

State institutions; Government departments ( local government); Budgetary and autonomous institutions (in terms of operations related to the fulfillment of public obligations, as well as the use of funds budget investments); Other participants in the budget process Order of the Ministry of Finance of Russia dated December 6, 2010 No. 162n “On Approval of the Chart of Accounts budget accounting and instructions for its use

Budget institutions Order of the Ministry of Finance of Russia dated December 16, 2010 No. 174n “On Approval of the Chart of Accounts for Accounting budget institutions and instructions for its use

Autonomous Institutions Order of the Ministry of Finance of Russia dated December 23, 2010 No. 183n “On Approval of the Chart of Accounts for Accounting autonomous institutions and instructions for its use

Income of medical institutions of the state and municipal health care systems from the provision of medical services provided to women during pregnancy, women and newborns during childbirth and in the postpartum period;

Borrowing fee material assets from the state reserve;

Other similar income1.

Group 200 "Expenses" is detailed by articles within which operations related to expenses are grouped:

210 “Remuneration of labor and accruals for payments on remuneration”;

220 "Payment for works, services";

230 "Servicing the state (municipal) debt";

240 "Gratuitous transfers to organizations";

250 "Gratuitous transfers to budgets";

260 "Social security";

270 "Expenses on transactions with assets";

290 "Other expenses".

Established items of expenditure in their own way economic content are an estimate of the cash costs of a military medical institution, an estimate of financing or an estimate of budget costs, and not the cost of medical and diagnostic work to provide medical care, which should be included in the cost of specific medical services.

From the point of view of the problem of calculating the cost of medical services provided by military medical institutions, it is necessary to know not only the types and composition of the costs incurred (elemental costs), but also where, for what type of services the costs were incurred, that is, a reasonable classification by cost items is necessary. It should also be noted that changes in the organization of accounting (budgetary) accounting in military medical institutions are caused by the need to obtain information on actual costs per unit of medical services provided.

1 See: Order of the Ministry of Finance of the Russian Federation dated December 21, 2012 No. 171 n “On approval of the Instructions on the procedure for applying budget classification Russian Federation for 2013 and for the planning period of 2014 and 2015”.

In this sense, the object of accounting for the costs of a military medical institution is the actual costs associated with the provision of medical services, which can be grouped according to various criteria in order to form indicators of the cost of medical care provided and its unit - medical services.

Grouping of costs by items of expenditure of the budget classification (according to economic elements) does not reflect the purpose and purpose of expenses, the relationship of costs with results, does not fully reflect their role in the technological process of providing medical services, the relationship with various factors. It is necessary to group the costs, highlight among them the main ones directly aimed at the provision of medical services, inextricably linked with the technological process of providing services, and the costs of servicing the process of providing services and management, i.e. group the costs according to their purpose and role in the process of providing medical services (basic, overhead, elemental, direct, indirect).

The internal organization of the process of providing medical services in military medical institutions is built on the principle of specialization. So, for example, in hospitals, specialized departments of various profiles (surgical, therapeutic, etc.) provide medical care to patients with only certain nosologies that correspond to the profile of the department. In these departments, a direct medical process is carried out, distinctive feature activities of which is the placement and maintenance of patients in them. At the same time, in such institutions there are paraclinical departments, which are also associated with the process of carrying out medical and diagnostic work, which is expressed in the provision of various types of diagnostic and therapeutic services by a specialized department of various profiles. In these departments, patients are not directly accommodated and are not kept during the treatment and diagnostic work (laboratory, endoscopy department, functional diagnostics, X-ray, etc.).

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Costs is a monetary expression costs production factors necessary for the enterprise to carry out its production and sales activities.

Accounting costs represent the cost of resources that are spent in the course of production and sale of goods and services, and this fact is reflected in the documents.

Economic costs - These are opportunity costs that express the most efficient use of the enterprise's own resources: accounting costs + implicit costs; or explicit costs + implicit costs. Explicit costs - the total cost of the enterprise to pay for the consumed factors of production. Implicit costs include the cost of lost opportunities associated with the use of own funds. Long-term and short-term costs. Fixed and variable costs.Fixed (conditionally fixed) costs (FC) - is the cost of resources that cannot be changed in the course of their application in the short run Variable (conditionally variable) costs (VC)- this is the cost of variable resources that are necessary for the production of a certain amount (volume) of a product or service. Total (Total or Gross) Costs (TC) − is the sum of fixed and variable costs. Average cost (AC) - is the total (total) costs per unit of output Average Variable Cost (AVC) – These are variable costs per unit of output: Average fixed costs (AFC) – are fixed costs per unit of output. Marginal Cost (MC) – this is the change in total (total) costs with a change in output Direct costs - These are costs that can be directly attributed to the cost of a product or service at the time they are incurred or accrued. Indirect costs - distributed by type of activity, structural divisions in proportion to the proceeds (income) from the sale of goods or services, i.e. they are conditionally included in the cost price. These costs include operating and management expenses enterprises Element costs- consisting of one component (element), for example, depreciation of fixed assets; complex costs- consisting of a whole complex of homogeneous costs, for example, general production costs of an enterprise production costs, those. formed during the normal course of production and labor processes; unproductive costs, which are caused by violations (shortcomings) of the organization and management of the production process at the enterprise. Current, future, forthcoming costs- classification is carried out according to the principle of the duration of the period of time in which they are incurred or to which they relate.

7.Methodology for determining the cost of medical services

Medical service, like any product, has a cost. Cost (C) is the sum of two constituent elements: costs and necessary profit.

C \u003d W x (1 + Pr), where

Z - the cost of medical services

Pr - the required amount of planned profit

The planned profit is set in the amount of funds needed for the development of a medical institution, to finance social programs and other economically justified expenses in the amount established by the regulatory body. At the same time, the level of profitability should not exceed 25 percent.

Basic concepts and their definitions:

Medical service - a certain set of medical (therapeutic, preventive, diagnostic) measures carried out in relation to one patient, having an independent complete value.

1. Calculation of the cost of simple and complex medical services

The methodology for calculating prices is based on determining the average costs for one service in each given unit of a medical institution (hospital departments, paraclinical units or outpatient (doctor's office) units). The calculations are based on cash expenses produced both directly by the division itself and indirect costs in the part in which they provide the provision of services in this unit, i.e. the costs calculated on the basis of the received cost of the service fully ensure the functioning of the unit.

When calculating the cost of a simple service, it is necessary to use its technological standard that has developed in this institution (the time spent on this service, quantitative and qualitative composition of medical workers providing this service, types and quantities of consumed medicines, preparations, etc.).

The calculation of the cost of services is made on the basis of established standards and the actual costs of the institution.

C \u003d (Zt + Hz + M + I + O + P + Sk) x (1 + Pr), where

Zt - the cost of wages of key personnel

Nz - accruals for wages of key personnel

M - material costs(medicines, etc. consumed in the process of providing a medical service in full)

I - expenses for soft inventory

O - depreciation of equipment used directly in the treatment and diagnostic process

P - nutrition of patients

Sk - indirect costs

A complex service can be represented as a set of simple services that reflect the technological process of providing medical care that has developed in each particular institution.

The calculation of the cost of a complex medical service (CC) is carried out by summing up the cost of simple medical services according to the relevant technological standard.

Сс = С1+С2+С3+С…, where

С1,С2,С… – the cost of simple medical services

8.Shaping financial plan medical organization. The financial analysis activities of a budgetary healthcare institution

The financial plan is a document that reflects the inflows and outflows of cash.

Revenue part medical organization:

Introductory and membership fee- these are one-time or regularly made contributions to cover administrative and business expenses, the procedure for collecting which is provided for in the Charter non-profit organization. At the expense of these funds, public associations are usually formed, consumer cooperatives, unions and associations;

Voluntary contributions are those voluntarily transferred by legal and individuals funds for statutory activities commercial organizations. These contributions are formed from funds and autonomous non-profit organizations (Article 7 and Article 10 of the Federal Law "On Non-Profit Organizations" No. 7-FZ of 01/12/2006);

Income from entrepreneurial activity- it net profit received from commercial activities in accordance with applicable law and the charter of a non-profit organization.

Expenditure part:

The expenses reflected in the financial plan should be as close as possible to the statutory goals and objectives of the non-profit organization;

The purpose and procedure for the formation of articles should be clear to consumers of this information.

When drawing up a financial plan, the balance principle must be observed financial planning, assuming equality of income and expenses.

Formation of financial plans can be carried out in two ways:

1. a non-profit organization starts from its goals and objectives in the implementation of a program or project, within the framework of which the costs necessary for the successful implementation of the goals are calculated;

2. based on available financial opportunities non-profit organization, the question is raised about the use of these funds to solve current problems or their possible direction for long-term programs or projects.

The mechanism for drawing up a financial plan:

The stage of forecasting possible sources of financial resources;

After the stage of forecasting possible sources of financial resources, they proceed to the distribution of planned income to finance specific programs and activities;

The distribution stage is a sequence of procedures.

Financial analysis of healthcare facilities. It is customary to distinguish three main types (directions) of financial analysis:

1. Analysis of property (property, capital) of the organization;

2. Analysis financial activities;

3. Analysis of the financial condition (position).

The analysis of financial activity is intended to characterize the financial results, the effectiveness of the medical institution for certain period activities (month, quarter, year, etc.) regardless of the starting state. The financial condition is characterized by security financial resources necessary for the normal functioning of the organization, their appropriate placement and efficient use, financial relationships with other legal entities and individuals, solvency and financial stability. universal document, reflecting both the property of a medical institution and its financial condition, and financial results, is an balance sheet. However, unlike enterprises and commercial organizations providing medical services, traditional methods balance sheet analysis for budgetary medical institutions are not always suitable. This is due to the following: Firstly, budgetary (state and municipal) medical institutions do not own property and therefore cannot sell any of their fixed assets to improve their financial condition. Consequently, fixed assets - the largest balance sheet item fall out of the scope of real economic relations. Secondly, big influence balance sheet indicators are subject to periodic revaluations of fixed assets. Meanwhile, an increase in the cost of fixed assets does not improve the real financial position budget medical institution. Thirdly, medical institutions usually maintain a single balance sheet for all sources of funds. Under these conditions, the analysis of the balance sheet is not very indicative - a separate analysis of the use of funds from the budget, the means of compulsory medical insurance, and entrepreneurial activity is needed. There are two main groups of factors that affect both the results of financial activity and the financial condition of a medical institution: 1) External factors: - system of financing (payment for medical services rendered); - the level of prices (tariffs) - in the provision of paid services and in CHI system; - the value of per capita standards; - taxation system, etc. 2) Internal factors: - the structure of the medical institution; - performance indicators of the institution and its divisions; - incentive system (remuneration system), etc.

9.Analysis of the use of material resources and medicines in medical institutions

Saving material resources is of paramount importance for industries material production. At the same time, it does not lose its significance for budgetary institutions, where it is expressed in compliance with established consumption rates. certain types materials for specific jobs. In this regard, in the process of analysis, in order to assess the level of use of material assets, their actual consumption is compared with the normative one. The result is expressed in savings or overspending of certain types of material resources. At the same time, it should be borne in mind that not every saving deserves a positive assessment. Of particular importance is not savings in general, but by what means it is achieved. For example, savings in the cost of medicines, if it is caused by the deterioration of the treatment of patients, should be considered as the most negative phenomenon. The savings resulting from the more economical use of materials, fuel, tools, etc., deserves every encouragement. Therefore, it is the possibility of obtaining such savings that should be identified in the process of analyzing the efficiency of the use of material resources.

In budgetary organizations, at present, expenditure rates are not established for all groups of materials. The amount of their expenditure primarily depends on the provision of the institution with the appropriate types of values, the need for them, as well as the possibility of obtaining savings.

But at the same time, for a number of groups of materials, the planned norms have been approved and must be observed. Such materials include food, medicines, alcohol, dressings, fuel and fuel, Construction Materials, materials for prosthetics, as well as some types of household materials (washing powder, soap, etc.).

Depending on the type of wealth standard flow can be both in kind and in value terms.

For most materials (alcohol, dressings, fuel and fuels and lubricants, building and household materials), in the process of analyzing the effectiveness of their use, it is advisable to compare the actual consumption with natural norms. However, it must be borne in mind that these norms should not be static. When calculating and approving them, the emerging trends in the consumption of relevant materials, the possibility of reducing their consumption due to the use of new methods and technologies of work, should be taken into account. To develop progressive norms, first of all, it is necessary to analyze the dynamics of the actual specific consumption over a number of years, and then, based on the identified trends and the clarified reasons for these changes, establish the optimal value of the norm, taking into account the possibility of obtaining cost savings without compromising the quality of services provided.

Medical service is a type of medical care provided

medical workers and public health institutions

The medical service begins to act as a specific product,

which has the following distinctive properties:

Intangibility (a patient who comes to see a doctor cannot

know the result of the visit in advance);

Inseparability from the source of the service (patient enrolled in

a certain doctor, will receive the wrong service if he gets in because of

the absence of this doctor to another);

Variability in quality (one and the same medical service

doctors of different qualifications render differently, and even the same

the doctor can help the patient in different ways, depending on his

states).

A medical service can be detailed and simple.

A detailed medical service is understood as an elementary,

indivisible service. For example, for a hospital with detailed services

type of bacteriological examination operating block and

other. If some detailed services provided by individual

departments of the institution (for example, admissions department,

bacteriological laboratory and others), will be separately

calculated, then the cost of maintaining these units

(the wages of their workers, the material

resources) should be included in the overhead costs of the institution. At

calculation of the cost of a detailed service, you must use

established in this institution its technological standard

(time spent on this service, quantitative and

qualitative composition of medical workers producing this

service, types and quantity of consumed medicines, preparations and

A simple service can be represented as a collection

detailed services reflecting the prevailing in each specific

institution, the technological process of providing medical care for

this nosology.

A simple service is understood as a complete case for

a certain nosology: for hospitals - a treated patient, for

outpatient clinics - completed case

treatment, with the exception of dental clinics, where under

a simple service is understood as a sanitized patient, for ambulance services

assistance - departure and treatment. List of simple medical

services can be determined either by the institution itself or

use the list approved by the administration (or body

health department in case of delegating these rights to it)

this territory in accordance with the

medical and economic standards. When developing a list

medical services, the age factor can be taken into account, as well as

the factor of complexity of providing this type of service, due to

the presence of concomitant diseases, complications, etc.

To determine the established standard for the provision of each type

a simple medical service from a list that reflects it

technological process, or a large array is processed

information from case histories or outpatient cards,

or in the absence of these possibilities, the method is used

expert assessments.

Composition of costs included in the cost of medical services

The cost of medical services is a cost estimate

materials used in the process of rendering (production) of services,

fixed assets, fuel, energy, labor resources, as well as

other costs of its production.

economic elements and costing items.

The grouping of costs by calculation items reflects their

composition depending on the direction of expenditures for the provision

(production) services.

To the costs attributable to the cost of the service, in accordance

with operating system financial statements in budgetary

organizations include:

Labor costs accrued for all reasons (art.

1 budget estimate);

Deductions for social insurance(Article 2 of the budget estimate);

Compulsory health insurance contributions

employees (if a decision is made to include these costs in

cost of services for budget organizations);

Stationery and self-supporting expenses (item 3 of the budget estimate);

Expenses for business trips and business trips (Article 4

budget estimate);

Food expenses (item 9 of the budget estimate);

Expenses for medicines (art. 10 of the budget estimate);

Amounts of depreciation deductions for full restoration

fixed assets (calculated based on the book value

fixed assets and approved in in due course norms

wear), while for machinery, equipment and transport

depreciation is terminated after the expiration of

normative period of their service, subject to the complete transfer of all

cost of production costs;

Depreciation of soft equipment and uniforms (calculated

based actual cost soft stock and uniforms

and their standard service life);

Capital repairs of buildings and structures (Article 16 of the budget

cost estimates);

Other expenses, including training expenses, for production

student practice, research and acquisition

books for libraries, costs associated with the acquisition by the institution

licenses and certificates (Article 18 of the budget estimate).

Costs charged to cost do not include:

The cost of purchasing equipment (Article 17 of the budget

The cost of purchasing soft equipment and uniforms

(Article 14 of the budget estimate);

Capital investments (Articles 13, 15 of the budget estimate);

Fines, penalties, forfeits and other types of sanctions for violation

contractual relationship.

Thus, we can say that the total cost of all

services rendered is equal to the value of the budget estimate minus art. 12,

14 and increased by the amount of depreciation deductions for the main

funds and wear and tear of soft stock.

The grouping of costs by economic elements reflects their

distribution according to economic content, regardless of form

use in the production (rendering) of a particular type of service.

When determining the cost of any type of medical services

the following grouping of costs by economic

elements:

Labor costs;

Accruals for wages;

Direct material costs;

Overheads.

Labor costs are the costs of paying

labor of medical workers performing services proportional to

the time spent on the production of the service and the complexity of the service

(if it is taken into account in the tariff agreement).

Payroll includes the cost of

payment of contributions to state social insurance.

Direct material costs include the cost

consumed in the process of providing medical services in full

(medicines, dressings, disposable supplies,

food, etc.) or partially (depreciation of medical

equipment used in the provision of this medical

services, depreciation of low-value and consumable items)

material resources.

Overhead costs for the institution include all types of

expenses not directly related to the provision of medical

services (stationery and household expenses, depreciation

non-medical equipment, wages

administrative and managerial personnel, travel expenses

other).

The cost of health care services: calculation and analysis; direction of decline

The calculation of the cost of services is prescribed in the "Instructions for calculating the cost of medical services (temporary), approved by the Ministry of Health N 01-23 / 4-10 and the Russian Academy of Medical Sciences N 01-02 / 41 dated 11/10/1999 and (hereinafter referred to as the Instruction for calculating the cost medical services)

The calculation of the price of medical services is based on actual costs and planned or standard costs of medical institutions and their structural divisions

Indicators used to calculate the price of the service

All types of expenses of the institution and separate structural units;

Fund of working hours of medical personnel;

The number of treated patients in the institution as a whole and in specialized departments;

Planned and actual indicators on the number of treated patients:

By institution;

by departments;

certain nosological forms of diseases

The cost of the service is expressed in terms of monetary form current costs of the enterprise for the production and sale of services.

There are: Technological, Workshop cost Production and Commercial (full) cost

The calculation of the costs of medical services is carried out taking into account all the costs of the health facility, its structural divisions, in which the relevant services are performed, and the time spent on their implementation. Drug expenses. funds used for therapeutic and prophylactic purposes are taken into account when calculating the cost of patient management protocols and are not taken into account when calculating the cost of services.

The costs of the institution for the purposes of calculation are divided into:

1) for direct (technologically related to the implementation of services and consumed in the process of its implementation): 211 - wages (main personnel); 213 - accruals for wages; 340 - material costs (medicines, dressings, disposable medical supplies); 310 - the share of soft inventory and medical equipment depreciation consumed in the process of providing the service;

2) overhead or indirect (necessary to ensure the activities of health facilities and the provision of medical services, but not consumed directly in the process of providing the service): - labor costs of general institution personnel; - accruals for wages; - household expenses (consumables and supplies, fuel, payment for communication services, utilities, current repair of equipment and inventory, buildings and structures, rental of premises and other property; wear is not honey. equipment and soft stock; costs for licensing, accreditation, certification, staff training, taxes; other current expenses; operating, organizational, commercial expenses, etc., etc.

Calculation of costs for simple medical services:

The calculation of the cost of a simple medical service (C) is carried out according to the formula:

C \u003d Sp + Sk \u003d Zt + Nz + M + I + O + P,

where Sp - direct costs, Sk - indirect costs, Zt - labor costs, Nz - accruals for wages, M - expenses for medicines, dressings, etc., I - wear of soft equipment, O - wear of equipment, P - other expenses.

Direct costs. To determine the cost of wages for all key personnel, the main wage and additional wages are calculated separately, that is, the amount of compensation payments. The calculations do not take into account: bonuses and material help, payment for additionally provided (in excess of provided by law) vacations for employees

The calculation of labor costs for a specific medical service (Zt.us) is carried out separately for each category of personnel based on the average salary of employees by unit in accordance with the tariff lists and established standards labor costs for these services.

where Zt.vr, Zt.sr - wage fund of the corresponding category of personnel for billing period;

Fr.vr, Fr.sr - the working time fund of the corresponding category of personnel, calculated in conventional units labor intensity, for the billing period;

tvr, tav - the time for the provision of medical services by the corresponding category of personnel in conventional units of labor intensity;

Labor intensity is measured by the time spent on the provision of medical services. In order to simplify the calculations, it is advisable to measure the labor input in conventional units of labor input (LUT), taking the time equal to 10 minutes as 1 LUT.

Kisp.vr, Kisp.sr, - normative coefficient the use of working time of medical personnel directly for medical and diagnostic work, research, procedures.

AT general view Kisp. is determined by the formula:

where Fisp.vr. - a fund for the use of time for the direct conduct of medical and diagnostic work. The coefficients for the use of working time are given in the Table in the temporary instruction.

F r.vr - the established working time fund of medical personnel in accordance with the instructions of the Ministry of Labor and social development Russia for the corresponding billing period.

Total labor costs for a specific medical service:

Zt.us \u003d Zt x (1 + Ku) x (1 + Kd),

where Ku is the salary coefficient of general institution personnel,

Kd - coefficient of additional wages.

Payroll accruals (Nz) are established by the legislation of the Russian Federation as a percentage of the wage fund.

When calculating the costs of material resources (M), fully consumed in the process of providing services, the costs are taken into account in accordance with Art. "Medicines, dressings and other medical expenses" of the ECR - based on data on actual expenses for the health facility as a whole and for its structural divisions.

In general, the cost of medicines can be determined by the formula:

where M - material resources, fully consumed in the process of providing services

Svr., Sav. - the number of positions of doctors and middle staff of the department, respectively;

Fr.vr, Fr.sr - the annual fund of working hours of the corresponding category of personnel, calculated in conventional units of labor intensity (UET);

tvr, tav - the time for the provision of medical services (labor intensity) by the corresponding category of personnel, calculated in conventional units of labor intensity (UT);

Kisp.vr, Kisp.sr, - the normative coefficient of the use of working time of the positions of medical personnel directly for the conduct of medical and diagnostic work, research, procedures;

The calculation of the share of wear of soft inventory (I) is carried out according to the standard of its wear in accordance with current regulations, documents and prices for the calculation period. Calculation of the share of wear honey. equipment is calculated by calculating the depreciation of equipment included in fixed assets. Depreciation is accounted for in proportion to the duration of the service. Annual amount depreciation (Gi) of each type of equipment is calculated on the basis of the book value of fixed assets (Bos): Gi = Bos * Ngi, where Hgi is the annual depreciation rate.

Indirect costs are transferred to the cost of the service:

Indirect costs (IC) are the costs incurred by an institution to implement economic activity, management, provision of services that cannot be directly attributed to their cost.

The salary of general institution staff (Zu) is taken into account when calculating the cost of a medical service through the salary ratio of general institution staff (Ku) to the basic salary of the main staff (Zt_osn):

Zu \u003d Zt.osn x Ku

General staff payroll accruals are calculated in the same way as key staff payroll accruals:

Other indirect costs In the cost of medical services, indirect costs are included in proportion to the direct costs (Sp) attributable to the service.

To account for indirect costs in the cost of a particular service, their coefficient (Kcr) is calculated:

Kkr \u003d Sk / Sp,

Skus \u003d Sp x Kkr,

where Skus - indirect costs included in the cost of a particular medical service.

The cost of a specific medical service is calculated by summing the results for each type of cost:

Sus = Ztus + Nzus + Mus + Ius + Ous + Skus

Calculation of costs for complex and complex medical services: determined by summing up the costs of simple services in accordance with the nomenclature and frequency of simple medical services. services that are part of a complex and complex. This should take into account the marginal components of costs, characterized by the value of additional. the costs required to simultaneously perform one additional simple service according to the composition of the complex one. Also, the costs of paying for the cost of services performed in other health facilities (in the absence of the possibility of their implementation in this health facility) should be taken into account.

Directions for reduction: we need a base of comparison by years, analyzes the contribution of each of the parameters separately to the cost for each year and finds out where the largest growth was recorded, this parameter is given more attention, it seeks reserves

The property condition of a healthcare facility can be characterized by the sum of working capital and fixed capital.

The working capital of a medical institution includes cash, securities belonging to this medical institution, stocks of raw materials and receivables.

The amount of fixed capital of a healthcare facility includes the active part of fixed assets, construction in progress, intangible assets and long term investments. Long term investment represent financial investments abstracted from the turnover of the healthcare facility. Intangible assets include what characterizes the value of the intellectual property of a medical institution.

The largest share of fixed capital is fixed assets.

fixed assets

Fixed assets - means of labor that are involved in the process of creation, work, services, while maintaining a natural-material form, and transfer their value to the cost of the created service in parts as they wear out. This part acts in the form of percentage deductions as wear and tear. To fixed assets include buildings, structures and their associated infrastructure (water supply, sewerage, ventilation, etc.), as well as medical equipment and apparatus. As part of fixed assets, an active part is distinguished, that is, what is constantly used in the treatment, diagnostic and rehabilitation process (devices, devices, parts of medical equipment), and a passive part (buildings, structures, etc.). The ratio of the active and passive parts of fixed assets is approximately one to four.

The valuation of fixed assets has three stages: initial, restoration, residual.

Initial(Op) = acquisition costs + shipping + storage. Restorative= Op, taking into account the revaluation.

In our country, constant revaluation of fixed assets began to be carried out since 1992 (previously they were carried out once every 5 years). In this case, the inflation rate is used. But at this rate of inflation today replacement cost does not give a real assessment of the existing value of fixed assets, since the replacement cost of worn-out equipment is higher than the balance sheet estimate, but the quality of the equipment does not meet the requirements for operation.

Residual(Oo) \u003d Op - Wear

Distinguish between physical and moral depreciation.

Physical depreciation (IF) is the loss of technical and economic properties. There are two types of methods that determine physical wear: by service life and by technical condition.

By service life:

If \u003d Tn * [Tf: (100-L)%], where Tf and Tn are the actual and standard service life, L - liquidation value object in % of the book value.

Moral depreciation (Im) - premature, before the expiration of the physical depreciation period, the backlog of equipment in terms of its technical characteristics. There are two methods for valuing fixed assets:

1) a decrease in the value of fixed assets as a result of a reduction in labor costs for their restoration.

Im = Pb: [(1 - Mon)%], where Pb, Mon - production of basic and new fixed assets.

2) decrease in the efficiency of fixed assets as a result of the introduction of new ones.

Im \u003d Fv: [(1 - Fp)%] , where: Fv, Fp - replacement and initial cost of labor instruments.

The organization may also define liquidation value which is the difference between two values: the cost of scrap from the disposal of equipment or the proceeds from its sale (if fixed assets are received by another enterprise for further exploitation) and the cost of dismantling this equipment.

Complete depreciation of fixed assets requires the replacement of existing ones with new ones, regardless of the type of wear.

Monetary expression of the degree of wear fixed assets is determined by depreciation.

Under depreciation should be understood as actions related to taking into account the depreciation of property during the period of their beneficial use and ensuring the transfer of part of their value to the service or work performed.

Useful life- this is the period during which the operation of the facility must generate income for the institution or serve to achieve the goals of its activities.

The amount of depreciation, expressed as a percentage of the original (book) value is called annual depreciation rate. Uniform depreciation rates for the full restoration of fixed assets National economy Russia, incl. health care, are summarized in the directory in accordance with the assigned codes of the entire classification of fixed assets.

The depreciation rate (Na) is calculated based on the expected full restoration (renovation) of fixed assets using the formula:

T*Sp

Where Sp - the initial cost of fixed assets;

Sl - liquidation value of fixed assets;

T is the useful life of fixed assets, years.

The effective use of the fixed assets of a medical institution depends on their rational use, which is influenced by many factors that ensure the operation of hospitals, clinics, rehabilitation centers, etc. These factors may include: actual bed occupancy, duration of hospital stay, residual value of medical equipment, Information Support and computerization of the medical and production process, the normative mode of operation of the equipment, the workload of the buildings of the medical institution, the time and duration of the current and overhauls buildings and equipment, etc.

Analysis of the state and efficiency of the use of fixed assets of the healthcare organization

Composition and structure of fixed assets.

Basic production assets;

Basic non-production assets;

Intangible assets. Fixed assets are material values ​​(instruments of labor) that are repeatedly involved in manufacturing process, do not change their natural-material form and transfer their value to finished products piecemeal as it wears out. By functional purpose fixed assets of the enterprise are divided into production and non-production.

Production assets are directly or indirectly related to the production of products. Non-productive funds serve to meet the cultural and everyday needs of workers.

By use, fixed assets are divided into those in operation and those in reserve, reserve, conservation, etc.

By ownership, fixed assets are divided into own and leased.

Fixed assets can be divided into active and passive. Active assets include such fixed assets that are directly involved in the production of products and have a direct direct impact on the volume of output. Active, as a rule, include machinery and equipment, vehicles and tools.

Analysis of fixed assets begins with an analysis of the presence, structure and movement of fixed assets in the enterprise. One of the main indicators in the analysis of fixed assets is the average annual cost of fixed assets. This cost can be calculated in the following way:

Fsr = Fper + (Fvv*Chm) / 12 – Fl *(12- M) / 12, (1) where Fs is the average annual cost of fixed assets; Fper - the initial (book) cost of fixed assets; Fvv - the cost of the introduced OS; Chm - the number of months of operation of the introduced OS; Fl - liquidation value; M - the number of months of operation of retired fixed assets. In addition, several more methods for calculating the cost of fixed assets are used. These methods include the chronological method of calculating the cost of fixed assets:

Фср = (½ *Ф1+Ф2+Ф3+….Фi-1+ ½ *Фi) / (n–1) (2)

where n - the number of periods (months, quarters, etc.) Фi - the cost of fixed assets in the i-th period; For simplicity, we often use the following formula to calculate the cost of fixed assets (simple arithmetic mean): Fav = (Fnach + Fkon) / 2 where Fnach - the cost of fixed assets at the beginning of the year;

Fkon - the cost of fixed assets for the end of the year. This section of the analysis also studies movement and technical condition fixed production assets. For this, the following indicators are calculated:

Update factor: Cobn = Fpost. / Fcon.; (4)

Retirement rate: Kvyb = Fvyb. / Fnach. ; (five)

Growth coefficient: Kpr. = Fpr./ Fnat., (6)

wear factor Kizn \u003d I / Cn, where

I - the amount of accrued depreciation of the OPF at the time of calculation, starting from the day the funds were put into operation, thousand rubles;

Cn is the initial cost of the OPF;

Fpost. - the cost of received fixed assets,

Fkon. - the cost of fixed assets at the end of the year,

Fvyb - the cost of retired fixed assets,

Fnach. - cost of fixed assets at the beginning of the year,

Fpr - the sum of the increase in fixed production assets. (Fpost. - Fvyb).

The next stage of the analysis is the analysis of the main indicators of the efficiency of the use of fixed assets.

The main indicator of the use of fixed assets is the rate of return on assets (an indicator of the efficiency of the use of fixed assets), calculated as the ratio of the value of manufactured products to the average annual cost of fixed assets:

Fotdacha \u003d VP / Fsr. (7).

To increase the return on assets, it is necessary:

An increase in the share of capital equipment and, as a result, a change in the structure of fixed assets;

The use of new equipment to replace obsolete models;

Sale of equipment that is not used or rarely used in the course of work;

Increase in the number of shifts, elimination of downtime in the company, which will lead to an increase in the utilization rate of machine time;

The transition to the manufacture of products with more high level added value;

General increase in production efficiency by increasing labor productivity, eliminating auxiliary fixed assets that are no longer needed

In addition, other indicators are calculated: capital intensity, the inverse indicator of capital productivity, characterizes the cost of production fixed assets per 1 rub. products.:

Femcapacity = Fsr. / VP (8),

In the process of analysis, the dynamics of the listed indicators, the implementation of the plan in terms of their level, the comparison of indicators in the analyzed years compared with the indicators in the base year are studied, inter-farm comparisons are carried out. For the purpose of a deeper analysis of the effectiveness of the use of fixed assets, the return on assets is determined for all fixed assets. To calculate the influence of factors on the increase in capital productivity of equipment, the method of chain substitutions is used. In this analysis, the values ​​of the analyzed year are gradually put into the formula instead of the values ​​of the base year and the influence of each of the factors is calculated: the structure of the equipment, all-day downtime, shift ratio, intra-shift downtime, average hourly output. The next stage of the analysis is the determination of capital-labor ratio (analysis of the provision of the enterprise with fixed assets). This indicator is defined as the ratio of the average annual cost of all fixed assets to the average number of employees in the enterprise:

Fvoor.=Fsr./ P (9),

where P is the number of employees at the enterprise (includes all workers, engineers and administrative staff). This indicator shows the cost of fixed assets attributable to one worker.

To calculate the efficiency of the use of fixed assets, the profitability indicators of fixed assets are calculated:

Overall profitability(P0, %)

P0 \u003d 100 x Pb / (Cav.g + Co.s),

where Pb - total (balance sheet) profit; Ssr.g - the average annual cost of fixed production assets; Сo.с - the average annual cost of working capital.

Estimated profitability (Рр)

PP \u003d 100 (Pb - Pp) / (Cav.g + Co.s),

where Pp - various payments and taxes from the total profit.

The indicator of profitability of production, in addition to the efficiency of the use of fixed assets, also shows the efficiency of the use of working capital.

Question

Identification and analysis of reserves and factors that determine the main directions for improving the efficiency of healthcare organizations

- increasing the autonomy and independence of healthcare organizations:

continuation of the phased transfer of medical organizations to enterprises on the right of economic management, including phased implementation in healthcare organizations international standards financial reporting;

providing government organizations health care greater autonomy in the adoption management decisions;

rational delineation of functions and powers between healthcare entities;

development of an effective algorithm for interaction between healthcare and social security organizations;

ensuring continuity in the management of the patient at all stages (stages of medical services);

- stimulating the development of the private sector:

systematic improvement of the relevant regulatory and methodological framework for the development of the private sector in health care;

elimination of unnecessary administrative barriers;

development and implementation of mechanisms to support and develop socially oriented corporate medical networks and organizations interested in providing guaranteed volume of free medical care (guaranteed volume of free medical care), implementation government programs prevention of diseases and promotion of a healthy lifestyle of the population,

including the adoption of measures to involve private health care providers in the implementation of state order;

phased implementation of the public-private partnership program

in healthcare, including activities for the transfer of fixed assets (buildings, equipment) to trust management and long-term lease to private medical organizations;

- improvement personnel policy in healthcare organizations:

development of a concept for the development of human resources for health care, including planning for the development of human resources in the health care system and mechanisms for increasing the efficiency of its use;

expanding the practice of forming targeted orders of local executive bodies for the training of healthcare professionals;

provision and creation regulatory framework to attract managers

with economic education in the management of healthcare organizations and training them in management in healthcare;

improving the system of remuneration of medical workers;

raising the social status and prestige of the profession of medical workers, including through mass information campaigns

in support and coverage professional activity doctors;

development of republican and regional programs professional development of physicians, including the development of institutions of professional reputation and professional competition;

increasing the role and support of professional associations of medical workers (professional NGOs);

development and implementation of mechanisms for social protection medical workers, including the compilation of a social package for them;

development and implementation of a system of preventive measures

for medical workers in case of a threat of the spread of quarantine and especially dangerous infections;

- development of informatization in healthcare:

further improvement and implementation of the UHMIS (unified Information system healthcare);

implementation of clinical algorithms, protocols and other standards in the UHMIS.

The costs of a medical institution have their own characteristics, since medical activities and the procedure for its financing are specific.

It takes into account the requirements of medical standards and procedures, the classification of KOSGU, orders of the Ministry of Health of the Russian Federation.

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The classification of expenses of a medical institution is carried out, direct and indirect expenses and their types are considered.

Classification of expenses of a medical institution

It is traditional to divide expenses into direct and indirect, which relate to the general activities of a medical institution. Let's take a closer look at these groups and their content.

Direct expenses of a medical organization

As the name of this group implies, it includes those costs that are closely related to the provision of medical care. That is, such costs can be considered direct calculation, determining the cost of a unit of medical services.

Direct costs, in turn, are divided into several groups.

1. Salaries of doctors and other health workers. In KOSGU, which is familiar to economists, these direct costs refer to code 211.
2. The classification of expenses also includes material expenses, which in medical institutions are divided into the following:
   • medical expenses, medicines, dressings (Art. 341 KOSGU);
   • food expenses;
   • soft inventory.

An analysis of the previous indicators allows us to find out how much dressing materials, syringes or medicines are spent on average per patient. This information can be carried over to future plans.

With soft inventory, the situation is different, the rationing for it is regulated by the old order of the USSR Ministry of Health No. 710 dated 09/15/1988, where the equipment tables are presented.

It should only be noted that the cost of such equipment is calculated per bed, as well as for the medical position that directly provides medical services.

The classification of food expenses also has some features that need to be considered. So, in a day hospital and in a regular hospital, a menu is usually compiled, according to which expenses are planned. If such costs are not calculated, then they cannot be taken into account in planning.

1. An important group in the classification under consideration is depreciation and wear and tear of medical equipment and equipment.

These accounting procedures are related to the recovery of the use of property, plant and equipment annually. Traditionally used to calculate depreciation and amortization linear way, according to which the costs are not made dependent on the bandwidth , but are set in accordance with the norms approved by the Government of the Russian Federation.

The depreciation rate is annual, therefore, it must be taken into account annually. Based on the annual calculation, depreciation costs can be taken into account on a monthly basis, as well as posting them to departments, which may be necessary for compiling internal reporting and planning.

When calculating depreciation expenses, it is necessary to carry out internal control, during which the compliance of the timesheet and balance sheet equipment is ensured. Standard equipment refers to instruments and devices that are distributed to offices, departments and profiles of medical care in accordance with the procedures for providing medical care.

When forming standard costs, it should be borne in mind that the equipment sheet is mandatory for implementation. If there is other equipment in the balance sheet of a medical institution that is not related to the standard equipment, then it generates excess expenses. From the point of view of modern models financial support it is inefficient.

General institutional (indirect) expenses of a medical institution

The classification of indirect costs is also a fairly large group, and they must be taken into account both in accounting and in financial planning.

How to determine which costs are indirect? Very simple - all those expenses that did not fall into the direct group, i.e. relating to the process of providing medical care are indirect.

So, the general or indirect costs include:

• transport services;
• payment for communication services;
• rent of buildings and premises;
• communal payments;
• payment for services and works under concluded contracts;
• depreciation of non-medical equipment;
• taxes;
• salary of other non-medical personnel, i.e. apparatus of people with non-medical education who accompany the activities of the medical institution. For example, this is administrative and managerial personnel (accounting, economists, personnel, etc.).

The totality of indirect and direct costs forms a complete standard cost or full actual cost.

At the same time, the difference between KOSGU and enlarged groups and actual ones is of great importance, since this is a good reserve for effective cost management in the future.

Fixed and variable costs of a medical institution

In addition to direct and indirect costs, another classification is used, mainly related to evaluation mechanisms. economic efficiency use of funds, and not with calculation and accounting:

• conditionally variable costs medical institutions;
• semi-fixed costs of medical institutions.

The division in this case occurs depending on how one or another type of expenditure affects the volume of medical care and medical services provided. So, if one or another type of expenses varies depending, for example, on the number of patients admitted to the hospital, then these are conditionally variable expenses. Accordingly, those costs that do not depend in any way on the number of services provided or on the number of patients treated will be conditionally fixed.

Conditionally variable costs:

• these include incentive payments for health workers, since this is not a permanent part of the salary. It forms conditionally variable costs in the event that doctors meet certain standards, when providing paid services, etc., that is, when, as a result of the provision of these services, a specialist receives a bonus or;
• variables are also the costs of medicines, dressings, soft inventory and other medical products;
• the group of variables can also include expenses for 226 KOSGU, that is, payment of expenses for contractual work and services. For example, some health facilities may not have a laundry or laboratory, in which case they turn to third parties conclude an agreement with them and they provide the necessary services;
• costs are also variable, which are directly dependent on the number of patients, occupied beds, volumes of medical services, etc.

Semi-fixed costs:

• their peculiarity is that the activity and its volumes do not affect them in any way;
• include expenses incurred in connection with the depreciation of equipment - medical and non-medical;
• the conditional nature of these costs is manifested in the fact that they include "overhead" costs of medical institutions - rent, electricity, utilities, etc.;
• compensation payments employees, for example, for overtime or harmful work, since these payments also do not depend on the volume of services provided.

The classification of expenses is also closely related to the income of a medical institution.

Therefore, there are also several features:

• on income within the framework of subsidies for state assignments, direct and indirect invoices are formed;
• on income within the framework of compulsory medical insurance subsidies, direct expenses for compulsory medical insurance and overhead costs according to the tariff are formed in proportion to the volume of services provided according to established standards;
• on income received as part of the provision of paid medical services, then the corresponding costs can be direct and indirect in the direction of paid services, they directly depend on the volume of services provided.

The allocation of conditional fixed and variable costs is necessary in order to be able to assess the cost structure of a medical institution, to analyze management decisions in the provision.

“Several different terms are used to denote the cost of resources consumed by a medical institution: costs, costs, expenses, cost. In most cases, they are used as synonyms. However, each of these terms has a specific meaning. Meanwhile, in many cases, these terms (with the exception of "cost") can also reflect the amount of resource consumption in physical or labor terms (electricity consumption, electricity costs; labor costs, etc.).

So, some authors believe that costs are part of the costs of manufacturing products, providing services sold in a given accounting period. The moment of transition of costs to the state of expenses is determined by the moment of shipment of products. Others, on the contrary, believe that, unlike expenses, costs are strictly tied to the reporting period. There is a point of view that the concept of "costs" is broader than the concept of "cost", which is the cost of simple reproduction, the current costs of a particular manufacturer.

A medical service, like any product, has a value, a monetary value, which is the price. Prices for services consist of two main elements: cost and profit.

To calculate prices for medical services, the concept of "profitability" is also used, which is generally determined by the ratio of profit to cost (there are other indicators of profitability).

“To calculate the cost of a medical service, the structural units of a medical institution are divided into main and auxiliary.

The main divisions of a medical institution include: specialized departments of hospitals, departments (offices) of polyclinics, diagnostic centers, outpatient (treatment and diagnostic) departments and offices in which the patient is provided with medical services.

Auxiliary units include general institutional services that support the activities of clinical and treatment and diagnostic units (administration, personnel department, accounting, medical statistics office, registry, pharmacy, sterilization, housekeeping services, etc.).

Meanwhile, another grouping is also used - with an additional allocation of service units. In this case, auxiliary units include units that help provide medical care: a pharmacy, sterilization, etc., and service units include units that ensure the functioning of the institution: administration, personnel department, accounting, housekeeping services, etc. ” .

We can cite the following classification of costs for the provision of medical services, grouped according to various criteria.

For departments involved in the provision of services:

Costs of the main medical (clinical) department;

The costs of paraclinical (treatment and diagnostic) services - laboratories, radiology departments, etc.;

Anesthesiology service costs;

Costs of the operating unit (wages of nurses and nurses of the operating unit, consumables, etc.);

Consultations of specialists of other services (ENT, ophthalmologist, etc.);

The costs of auxiliary (servicing) units - sterilization, procedural, etc.;

Household service costs;

Costs of administrative and management personnel (AMP).

The structure of tariffs for medical services usually consists of the indicated main blocks, some of which, depending on the adopted methodology, the specifics of the service, the procedure for calculating, may be excluded or replaced by others.

By participation in the provision of services (in relation to the process of providing services), the costs (costs) are divided into:

Basic;

Overhead.

The main ones are the costs directly related to the provision of services - salaries, medicines, medical instruments, etc. It should be noted that the costs of heating, electricity, water supply are also among the main costs.

Overhead expenses for the institution include all types of expenses that are not directly related to the provision of medical services (clerical and household expenses, depreciation of non-medical equipment, remuneration of administrative and management personnel, travel expenses, etc.).

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Costs is a monetary expression costs production factors necessary for the enterprise to carry out its production and sales activities.

Accounting costs represent the cost of resources that are spent in the course of production and sale of goods and services, and this fact is reflected in the documents.

Economic costs - These are opportunity costs that express the most efficient use of the enterprise's own resources: accounting costs + implicit costs; or explicit costs + implicit costs. Explicit costs - the total cost of the enterprise to pay for the consumed factors of production. Implicit costs include the cost of lost opportunities associated with the use of own funds. Long-term and short-term costs. Fixed and variable costs.Fixed (conditionally fixed) costs (FC) - is the cost of resources that cannot be changed in the course of their application in the short run Variable (conditionally variable) costs (VC)- this is the cost of variable resources that are necessary for the production of a certain amount (volume) of a product or service. Total (Total or Gross) Costs (TC) − is the sum of fixed and variable costs. Average cost (AC) - is the total (total) costs per unit of output Average Variable Cost (AVC) – These are variable costs per unit of output: Average fixed costs (AFC) – are fixed costs per unit of output. Marginal Cost (MC) – this is the change in total (total) costs with a change in output Direct costs - These are costs that can be directly attributed to the cost of a product or service at the time they are incurred or accrued. Indirect costs - distributed by type of activity, structural divisions in proportion to the proceeds (income) from the sale of goods or services, i.e. they are conditionally included in the cost price. These costs include operating and management costs of the enterprise. Element costs- consisting of one component (element), for example, depreciation of fixed assets; complex costs- consisting of a whole complex of homogeneous costs, for example, general production costs of an enterprise production costs, those. formed during the normal course of production and labor processes; unproductive costs, which are caused by violations (shortcomings) of the organization and management of the production process at the enterprise. Current, future, forthcoming costs- classification is carried out on the basis of the length of the time period in which they are incurred or to which they relate.

7.Methodology for determining the cost of medical services

Medical service, like any product, has a cost. Cost (C) is the sum of two constituent elements: costs and necessary profit.

C \u003d W x (1 + Pr), where

Z - the cost of medical services

Pr - the required amount of planned profit

The planned profit is set in the amount of funds necessary for the development of a medical institution, to finance social programs and other economically justified expenses in the amount established by the regulatory body. At the same time, the level of profitability should not exceed 25 percent.

Basic concepts and their definitions:

Medical service - a certain set of medical (therapeutic, preventive, diagnostic) measures carried out in relation to one patient, having an independent complete value.

1. Calculation of the cost of simple and complex medical services

The methodology for calculating prices is based on determining the average costs for one service in each given unit of a medical institution (hospital departments, paraclinical units or outpatient (doctor's office) units). The calculations are based on cash costs incurred both directly by the unit itself, and indirect costs in the part in which they provide the provision of services in this unit, i.e. the costs calculated on the basis of the received cost of the service fully ensure the functioning of the unit.

When calculating the cost of a simple service, it is necessary to use its technological standard that has developed in this institution (the time spent on this service, the quantitative and qualitative composition of medical workers providing this service, the types and quantities of medicines, preparations consumed, etc.).

The calculation of the cost of services is made on the basis of established standards and the actual costs of the institution.

C \u003d (Zt + Hz + M + I + O + P + Sk) x (1 + Pr), where

Зт - the cost of wages of key personnel

Nz - accruals for the remuneration of key personnel

M - material costs (medicines, etc. consumed in the process of providing medical services in full)

I - expenses for soft inventory

O - depreciation of equipment used directly in the treatment and diagnostic process

P - nutrition of patients

Sk - indirect costs

A complex service can be represented as a set of simple services that reflect the technological process of providing medical care that has developed in each particular institution.

The calculation of the cost of a complex medical service (CC) is carried out by summing up the cost of simple medical services according to the relevant technological standard.

Сс = С1+С2+С3+С…, where

С1,С2,С… – the cost of simple medical services

8.Formation of the financial plan of the medical organization. Financial analysis of the activities of a budgetary healthcare institution

The financial plan is a document that reflects the inflows and outflows of cash.

Income of a medical organization:

- entrance and membership fees - these are one-time or regular contributions to cover administrative and business expenses, the procedure for collecting which is provided for in the Charter of a non-profit organization. At the expense of these funds, public associations, consumer cooperatives, unions and associations are usually formed;

Voluntary contributions are funds voluntarily transferred by legal entities and individuals for the statutory activities of non-profit organizations. These contributions are formed from funds and autonomous non-profit organizations (Article 7 and Article 10 of the Federal Law "On Non-Profit Organizations" No. 7-FZ of 01/12/2006);

- business income is the net profit received from commercial activities in accordance with applicable law and the charter of a non-profit organization.

Expenditure part:

- the expenses reflected in the financial plan should be as close as possible to the statutory goals and objectives of the non-profit organization;

- the purpose and procedure for the formation of articles should be clear to consumers of this information.

When drawing up a financial plan, the balance principle of financial planning, which implies equality of income and expenses, must be observed.

Formation of financial plans can be carried out in two ways:

1. a non-profit organization starts from its goals and objectives in the implementation of a program or project, within the framework of which the costs necessary for the successful implementation of the goals are calculated;

2. Based on the available financial capabilities of a non-profit organization, the question is raised about the use of these funds to solve current problems or their possible direction for long-term programs or projects.

The mechanism for drawing up a financial plan:

— the stage of forecasting possible sources of financial resources;

- after the stage of forecasting possible sources of receipt of financial resources, they proceed to the distribution of planned income to finance specific programs, areas of activity;

- the distribution stage is a sequence of procedures.

Financial analysis of healthcare facilities. It is customary to distinguish three main types (directions) of financial analysis:

1. Analysis of property (property, capital) of the organization;

2. Analysis of financial activity;

3. Analysis of the financial condition (position).

The analysis of financial activity is intended to characterize the financial results, the efficiency of the medical institution for a certain period of activity (month, quarter, year, etc.) regardless of the starting state. The financial condition is characterized by the availability of financial resources necessary for the normal functioning of the organization, their appropriate placement and effective use, financial relationships with other legal entities and individuals, solvency and financial stability. A universal document reflecting both the property of a medical institution and its financial condition and financial results is the balance sheet. However, unlike enterprises and commercial organizations that provide medical services, traditional methods of balance analysis for budgetary medical institutions are not always suitable. This is due to the following: Firstly, budgetary (state and municipal) medical institutions do not own property and therefore cannot sell any of their fixed assets to improve their financial condition. Consequently, fixed assets, the largest balance sheet item, fall out of the sphere of real economic relations. Secondly, periodic revaluations of fixed assets have a great influence on balance sheet indicators. Meanwhile, an increase in the cost of fixed assets does not improve the real financial situation of a budgetary medical institution. Thirdly, medical institutions usually maintain a single balance sheet for all sources of funds. Under these conditions, the analysis of the balance sheet is not very indicative - a separate analysis of the use of funds from the budget, the means of compulsory medical insurance, and entrepreneurial activity is needed. There are two main groups of factors that affect both the results of financial activity and the financial condition of a medical institution: 1) External factors: - the system of financing (payment for medical services rendered); - the level of prices (tariffs) - in the provision of paid services and in the CHI system; - the value of per capita standards; — taxation system, etc. 2) Internal factors: - the structure of the medical institution; - performance indicators of the institution and its departments; - incentive system (remuneration system), etc.

9.Analysis of the use of material resources and medicines in medical institutions

Saving material resources is of paramount importance for the branches of material production. At the same time, it does not lose its significance for budgetary institutions, where it is expressed in compliance with the established norms for the consumption of certain types of materials when performing specific work. In this regard, in the process of analysis, in order to assess the level of use of material assets, their actual consumption is compared with the normative one. The result is expressed in savings or overspending of certain types of material resources. At the same time, it should be borne in mind that not every saving deserves a positive assessment. Of particular importance is not savings in general, but by what means it is achieved. For example, savings in the cost of medicines, if it is caused by the deterioration of the treatment of patients, should be considered as the most negative phenomenon. The savings resulting from the more economical use of materials, fuel, tools, etc., deserves every encouragement. Therefore, it is the possibility of obtaining such savings that should be identified in the process of analyzing the efficiency of the use of material resources.

In budgetary organizations, at present, expenditure rates are not established for all groups of materials. The amount of their expenditure primarily depends on the provision of the institution with the appropriate types of values, the need for them, as well as the possibility of obtaining savings.

But at the same time, for a number of groups of materials, the planned norms have been approved and must be observed. Such materials include food, medicines, alcohol, dressings, fuel and lubricants, building materials, materials for prosthetics, as well as some types of household materials (washing powder, soap, etc.).

Depending on the type of material assets, the standard consumption can be both in kind and in value terms.

For most materials (alcohol, dressings, fuel and fuels and lubricants, building and household materials), in the process of analyzing the effectiveness of their use, it is advisable to compare the actual consumption with natural norms. However, it must be borne in mind that these norms should not be static. When calculating and approving them, the emerging trends in the consumption of relevant materials, the possibility of reducing their consumption due to the use of new methods and technologies of work, should be taken into account. To develop progressive norms, first of all, it is necessary to analyze the dynamics of the actual specific consumption over a number of years, and then, based on the identified trends and the clarified reasons for these changes, establish the optimal value of the norm, taking into account the possibility of obtaining cost savings without compromising the quality of services provided.

Medical service is a type of medical care provided

medical workers and public health institutions

The medical service begins to act as a specific product,

which has the following distinctive properties:

- intangibility (a patient who comes to see a doctor cannot

know the result of the visit in advance);

— inseparability from the source of the service (the patient who signed up for

a certain doctor, will receive the wrong service if he gets in because of

the absence of this doctor to another);

— variability of quality (one and the same medical service

doctors of different qualifications render differently, and even the same

the doctor can help the patient in different ways, depending on his

states).

A medical service can be detailed and simple.

A detailed medical service is understood as an elementary,

indivisible service. For example, for a hospital with detailed services

type of bacteriological examination of the operating unit and

other. If some detailed services provided by individual

departments of the institution (for example, admissions department,

bacteriological laboratory and others), will be separately

calculated, then the cost of maintaining these units

(the wages of their workers, the material

resources) should be included in the overhead costs of the institution. At

calculation of the cost of a detailed service, you must use

established in this institution its technological standard

(time spent on this service, quantitative and

qualitative composition of medical workers producing this

service, types and quantity of consumed medicines, preparations and

A simple service can be represented as a collection

detailed services reflecting the prevailing in each specific

institution, the technological process of providing medical care for

this nosology.

A simple service is understood as a complete case for

a certain nosology: for hospitals - a treated patient, for

outpatient clinics - completed case

treatment, with the exception of dental clinics, where under

a simple service is understood as a sanitized patient, for ambulance services

assistance - departure and treatment. List of simple medical

services can be determined either by the institution itself or

use the list approved by the administration (or body

health department in case of delegating these rights to it)

this territory in accordance with the

medical and economic standards. When developing a list

medical services, the age factor can be taken into account, as well as

the factor of complexity of providing this type of service, due to

the presence of concomitant diseases, complications, etc.

To determine the established standard for the provision of each type

a simple medical service from a list that reflects it

technological process, or a large array is processed

information from case histories or outpatient cards,

or in the absence of these possibilities, the method is used

expert assessments.

Composition of costs included in the cost of medical services

The cost of medical services is a cost estimate

materials used in the process of rendering (production) of services,

fixed assets, fuel, energy, labor resources, as well as

other costs of its production.

economic elements and costing items.

The grouping of costs by calculation items reflects their

composition depending on the direction of expenditures for the provision

(production) services.

To the costs attributable to the cost of the service, in accordance

with the current accounting system in the budget

organizations include:

- labor costs accrued for all reasons (art.

1 budget estimate);

- deductions for social insurance (Article 2 of the budget estimate);

- deductions for compulsory health insurance

employees (if a decision is made to include these costs in

cost of services for budgetary organizations);

- office and self-supporting expenses (item 3 of the budget estimate);

- expenses for business trips and business trips (Article 4

budget estimate);

- food expenses (item 9 of the budget estimate);

- expenses for medicines (Article 10 of the budget estimate);

- the amount of depreciation deductions for a full restoration

fixed assets (calculated based on the book value

fixed assets and duly approved norms

wear), while for machinery, equipment and transport

depreciation is terminated after the expiration of

normative period of their service, subject to the complete transfer of all

cost of production costs;

- wear of soft equipment and uniforms (calculated

based on the actual cost of soft equipment and uniforms

and their standard service life);

- overhaul of buildings and structures (Article 16 of the budget

cost estimates);

— other expenses, including training expenses, for production

student practice, research and acquisition

books for libraries, costs associated with the acquisition by the institution

licenses and certificates (Article 18 of the budget estimate).

Costs charged to cost do not include:

- the cost of purchasing equipment (Article 17 of the budget

- the cost of purchasing soft equipment and uniforms

(Article 14 of the budget estimate);

— capital investments(Art. 13, 15 of the budget estimate);

- fines, penalties, forfeits and other types of sanctions for violation

contractual relationship.

Thus, we can say that the total cost of all

services rendered is equal to the value of the budget estimate minus art. 12,

14 and increased by the amount of depreciation deductions for the main

funds and wear and tear of soft stock.

The grouping of costs by economic elements reflects their

distribution according to economic content, regardless of form

use in the production (rendering) of a particular type of service.

When determining the cost of any type of medical services

the following grouping of costs by economic

elements:

- labor costs;

- payroll;

- direct material costs;

- overhead costs.

Labor costs are the costs of paying

labor of medical workers performing services proportional to

the time spent on the production of the service and the complexity of the service

(if it is taken into account in the tariff agreement).

Payroll includes the cost of

payment of contributions to state social insurance.

Direct material costs include the cost

consumed in the process of providing medical services in full

(medicines, dressings, disposable supplies,

food, etc.) or partially (depreciation of medical

equipment used in the provision of this medical

services, depreciation of low-value and consumable items)

material resources.

Overhead costs for the institution include all types of

expenses not directly related to the provision of medical

services (stationery and household expenses, depreciation

non-medical equipment, wages

administrative and managerial personnel, travel expenses

other).

The cost of health care services: calculation and analysis; direction of decline

The calculation of the cost of services is prescribed in the "Instructions for calculating the cost of medical services (temporary), approved by the Ministry of Health N 01-23 / 4-10 and the Russian Academy of Medical Sciences N 01-02 / 41 dated 11/10/1999 and (hereinafter referred to as the Instruction for calculating the cost medical services)

Calculation of the price for medical services is based on actual costs and planned or standard costs of medical institutions and their structural divisions

Indicators used to calculate the price of the service

All types of expenses of the institution and separate structural units;

Fund of working hours of medical personnel;

The number of treated patients in the institution as a whole and in specialized departments;

Planned and actual indicators on the number of treated patients:

By institution;

by departments;

certain nosological forms of diseases

The cost of the service is the current costs of the enterprise for the production and sale of the service, expressed in monetary terms.

There are: Technological, Workshop cost Production and Commercial (full) cost

The calculation of the costs of medical services is carried out taking into account all the costs of the health facility, its structural divisions, in which the relevant services are performed, and the time spent on their implementation. Drug expenses. funds used for therapeutic and prophylactic purposes are taken into account when calculating the cost of patient management protocols and are not taken into account when calculating the cost of services.

The costs of the institution for the purposes of calculation are divided into:

1) for direct (technologically related to the implementation of services and consumed in the process of its implementation): 211 - wages (main personnel); 213 - accruals for wages; 340 - material costs (medicines, dressings, disposable medical supplies); 310 - the share of soft inventory and medical equipment depreciation consumed in the process of providing the service;

2) overhead or indirect (necessary to ensure the activities of health facilities and the provision of medical services, but not consumed directly in the process of providing the service): - the cost of remuneration of general institution staff; - accruals for wages; - household expenses (consumables and supplies, fuel, payment for communication services, utilities, maintenance of equipment and inventory, buildings and structures, rental of premises and other property; depreciation of non-medical equipment and soft inventory; costs for licensing, accreditation , certification, staff training, taxes, other current expenses, operating, organizational, commercial expenses, etc., etc.

Calculation of costs for simple medical services:

The calculation of the cost of a simple medical service (C) is carried out according to the formula:

C \u003d Sp + Sk \u003d Zt + Nz + M + I + O + P,

where Sp - direct costs, Sk - indirect costs, Wt - labor costs, Nz - accruals for wages, M - expenses for medicines, dressings, etc., I - wear of soft equipment, O - wear of equipment, P - other expenses.

Direct costs. To determine the cost of wages for all key personnel, the main wage and additional wages are calculated separately, that is, the amount of compensation payments. The calculations do not take into account: bonuses and material assistance, payment of additionally provided (in excess of those provided by law) holidays for employees

The calculation of labor costs for a specific medical service (Zt.us) is carried out separately for each category of personnel on the basis of the average salary of employees by unit in accordance with the tariff lists and established standards for labor costs for the provision of these services.

where Zt.vr, Zt.sr - wage fund of the corresponding category of personnel for the billing period;

Fr.vr, Fr.sr - the working time fund of the corresponding category of personnel, calculated in conventional units of labor intensity, for the billing period;

tvr, tav — the time of rendering a medical service by the corresponding category of personnel in conventional units of labor intensity;

Labor intensity is measured by the time spent on the provision of medical services. In order to simplify the calculations, it is advisable to measure the labor input in conventional units of labor input (LUT), taking the time equal to 10 minutes as 1 LUT.

Kisp.vr, Kisp.sr, is the normative coefficient for the use of working time of medical personnel directly for medical and diagnostic work, research, and procedures.

In general, Kisp. is determined by the formula:

where Fisp.vr. - Fund for the use of time for the direct conduct of medical and diagnostic work. The coefficients for the use of working time are given in the Table in the temporary instruction.

F r.vr - the established fund of working hours of medical personnel in accordance with the instructions of the Ministry of Labor and Social Development of Russia for the corresponding billing period.

Total labor costs for a specific medical service:

Zt.us \u003d Zt x (1 + Ku) x (1 + Kd),

where Ku is the wage rate for general staff,

Kd - coefficient of additional wages.

Payroll accruals (Nz) are established by the legislation of the Russian Federation as a percentage of the wage fund.

When calculating the costs of material resources (M), fully consumed in the process of providing services, the costs are taken into account in accordance with Art. "Medicines, dressings and other medical expenses" of the ECR - based on data on actual expenses for the health facility as a whole and for its structural divisions.

In general, the cost of medicines can be determined by the formula:

where M is the material resources fully consumed in the process of providing the service

Svr., Sav. - the number of positions of doctors and middle staff of the department, respectively;

Fr.vr, Fr.sr - the annual fund of working hours of the corresponding category of personnel, calculated in conventional units of labor intensity (UET);

tvr, tav is the time of rendering a medical service (labor intensity) by the corresponding category of personnel, calculated in conventional units of labor intensity (UT);

Kisp.vr, Kisp.sr, is the normative coefficient for the use of working time of medical personnel positions directly for conducting diagnostic and treatment work, studies, procedures;

The calculation of the share of depreciation of soft inventory (I) is carried out according to the standard of its depreciation in accordance with the current norms, documents and prices for the calculation period. Calculation of the share of wear honey. equipment is calculated by calculating the depreciation of equipment included in fixed assets. Depreciation is accounted for in proportion to the duration of the service. The annual amount of depreciation (Gi) of each type of equipment is calculated on the basis of the book value of fixed assets (Bos): Gi = Bos * Ngi, where Hgi is the annual depreciation rate.

Indirect costs are transferred to the cost of the service:

Indirect costs (IC) are the costs of the institution for the implementation of economic activities, management, provision of services that cannot be directly attributed to their cost.

The salary of general institution staff (Zu) is taken into account when calculating the cost of a medical service through the salary ratio of general institution staff (Ku) to the basic salary of the main staff (Zt_osn):

Zu \u003d Zt.osn x Ku

General staff payroll accruals are calculated in the same way as key staff payroll accruals:

Other indirect costs In the cost of medical services, indirect costs are included in proportion to the direct costs (Sp) attributable to the service.

To account for indirect costs in the cost of a particular service, their coefficient (Kcr) is calculated:

Kkr \u003d Sk / Sp,

Skus \u003d Sp x Kkr,

where Skus are indirect costs included in the cost of a particular medical service.

The cost of a specific medical service is calculated by summing the results for each type of cost:

Sus = Ztus + Nzus + Mus + Ius + Ous + Skus

Calculation of costs for complex and complex medical services: determined by summing up the costs of simple services in accordance with the nomenclature and frequency of simple medical services. services that are part of a complex and complex. This should take into account the marginal components of costs, characterized by the value of additional. the costs required to simultaneously perform one additional simple service according to the composition of the complex one. Also, the costs of paying for the cost of services performed in other health facilities (in the absence of the possibility of their implementation in this health facility) should be taken into account.

Directions for reduction: we need a base of comparison by years, analyzes the contribution of each of the parameters separately to the cost for each year and finds out where the largest growth was recorded, this parameter is given more attention, it seeks reserves

The property condition of a healthcare facility can be characterized by the sum of working capital and fixed capital.

The working capital of a medical institution includes cash, securities belonging to this medical institution, stocks of raw materials and materials, and receivables.

The amount of fixed capital of a healthcare facility includes the active part of fixed assets, construction in progress, intangible assets and long-term investments. Long-term investments are financial investments diverted from the turnover of the healthcare facility. Intangible assets include what characterizes the value of the intellectual property of a medical institution.

The largest share of fixed capital is fixed assets.

fixed assets

Fixed assets - means of labor that are involved in the process of creation, work, services, while maintaining a natural-material form, and transfer their value to the cost of the created service in parts as they wear out. This part acts in the form of percentage deductions as wear and tear. To fixed assets include buildings, structures and their associated infrastructure (water supply, sewerage, ventilation, etc.), as well as medical equipment and apparatus. As part of fixed assets, an active part is distinguished, that is, what is constantly used in the treatment, diagnostic and rehabilitation process (devices, devices, parts of medical equipment), and a passive part (buildings, structures, etc.). The ratio of the active and passive parts of fixed assets is approximately one to four.

The valuation of fixed assets has three stages: initial, restoration, residual.

Initial(Op) = acquisition costs + shipping + storage. Restorative= Op, taking into account the revaluation.

In our country, constant revaluation of fixed assets began to be carried out since 1992 (previously they were carried out once every 5 years). In this case, the inflation rate is used. But with such a rate of inflation today, the replacement cost does not give a real assessment of the existing value of fixed assets, since the replacement cost of worn-out equipment is higher than the balance sheet estimate, but the quality of the equipment does not meet the requirements for operation.

Residual(Oo) \u003d Op - Wear

Distinguish between physical and moral depreciation.

Physical depreciation (IF) is the loss of technical and economic properties. There are two types of methods that determine physical wear: by service life and by technical condition.

By service life:

If = Tn * [Tf: (100-L)%] , where Tf and Tn are the actual and standard service life, L is the liquidation value of the object in% of the book value.

Moral depreciation (Im) - premature, before the expiration of the physical depreciation period, the backlog of equipment in terms of its technical characteristics. There are two methods for valuing fixed assets:

1) a decrease in the value of fixed assets as a result of a reduction in labor costs for their restoration.

Im = Pb: [(1 - Mon)%], where Pb, Mon - production of basic and new fixed assets.

2) decrease in the efficiency of fixed assets as a result of the introduction of new ones.

Im \u003d Fv: [(1 - Fp)%] , where: Fv, Fp - replacement and initial cost of labor instruments.

The organization may also define liquidation value which is the difference between two values: the cost of scrap from the elimination of equipment or proceeds from its sale (if the fixed assets are transferred to another enterprise for further operation) and the cost of dismantling this equipment.

Complete depreciation of fixed assets requires the replacement of existing ones with new ones, regardless of the type of wear.

Monetary expression of the degree of wear fixed assets is determined by depreciation.

Under depreciation should be understood as actions related to taking into account the depreciation of property during their useful life and ensuring the transfer of part of their value to the service or work performed.

Useful life- this is the period during which the operation of the facility must generate income for the institution or serve to achieve the goals of its activities.

The amount of depreciation, expressed as a percentage of the original (book) value is called annual depreciation rate. Uniform depreciation rates for the full restoration of fixed assets of the national economy of Russia, incl. health care, are summarized in the directory in accordance with the assigned codes of the entire classification of fixed assets.

The depreciation rate (Na) is calculated based on the expected full restoration (renovation) of fixed assets using the formula:

T*Sp

Where Sp - the initial cost of fixed assets;

Sl - liquidation value of fixed assets;

T is the useful life of fixed assets, years.

The effective use of fixed assets of a medical institution depends on their rational use, which is influenced by many factors that ensure the operation of hospitals, clinics, rehabilitation centers, etc. These factors may be: actual bed occupancy, duration of hospitalization, residual value of medical equipment, information support and computerization of the medical and production process, standard operation of equipment, workload of buildings of a medical institution, time and duration of current and major repairs of buildings and equipment, and others.

Analysis of the state and efficiency of the use of fixed assets of the healthcare organization

Composition and structure of fixed assets.

— main production assets;

- fixed non-production assets;

— intangible assets. Fixed assets are material values ​​(instruments of labor) that are repeatedly involved in the production process, do not change their natural-material form and transfer their value to finished products in parts as they wear out. According to the functional purpose, the fixed assets of the enterprise are divided into production and non-production.

Production assets are directly or indirectly related to the production of products. Non-productive funds serve to meet the cultural and everyday needs of workers.

By use, fixed assets are divided into those in operation and those in reserve, reserve, conservation, etc.

By ownership, fixed assets are divided into own and leased.

Fixed assets can be divided into active and passive. Active assets include such fixed assets that are directly involved in the production of products and have a direct direct impact on the volume of output. Active, as a rule, include machinery and equipment, vehicles and tools.

Analysis of fixed assets begins with an analysis of the presence, structure and movement of fixed assets in the enterprise. One of the main indicators in the analysis of fixed assets is the average annual cost of fixed assets. This cost can be calculated as follows:

Fsr = Fper + (Fvv*Chm) / 12 – Fl *(12- M) / 12, (1) where Fs is the average annual cost of fixed assets; Fper - the initial (book) cost of fixed assets; Fvv - the cost of the introduced OS; Chm - the number of months of operation of the introduced OS; Fl - liquidation value; M - the number of months of operation of retired fixed assets. In addition, several more methods for calculating the cost of fixed assets are used. These methods include the chronological method of calculating the cost of fixed assets:

Фср = (½ *Ф1+Ф2+Ф3+….Фi-1+ ½ *Фi) / (n–1) (2)

where n is the number of periods (months, quarters, etc.) Фi is the cost of fixed assets in the i-th period; To simplify, most often, the following formula is used to calculate the cost of fixed assets (simple arithmetic average): Fav = (Fnach + Fkon) / 2 where Fnach is the cost of fixed assets at the beginning of the year;

Fcon - the cost of fixed assets at the end of the year. This section of the analysis also examines the movement and technical condition of fixed assets. For this, the following indicators are calculated:

Update factor: Cobn = Fpost. / Fcon.; (4)

Retirement rate: Kvyb = Fvyb. / Fnach. ; (five)

Growth coefficient: Kpr. = Fpr./ Fnat., (6)

wear factor Kizn \u003d I / Cn, where

I - the amount of accrued depreciation of the OPF at the time of calculation, starting from the day the funds were put into operation, thousand rubles;

Cn is the initial cost of the OPF;

Fpost. - the cost of received fixed assets,

Fkon. - the cost of fixed assets at the end of the year,

Fvyb - the cost of retired fixed assets,

Fnach. - cost of fixed assets at the beginning of the year,

Fpr - the sum of the increase in fixed production assets. (Fpost. - Fvyb).

The next stage of the analysis is the analysis of the main indicators of the efficiency of the use of fixed assets.

The main indicator of the use of fixed assets is the rate of return on assets (an indicator of the efficiency of the use of fixed assets), calculated as the ratio of the value of manufactured products to the average annual cost of fixed assets:

Fotdacha \u003d VP / Fsr. (7).

To increase the return on assets, it is necessary:

— an increase in the share of capital equipment and, as a result, a change in the structure of fixed assets;

- the use of new equipment to replace obsolete models;

– sale of equipment that is not used or rarely used in the course of work;

- increasing the number of shifts, eliminating downtime at the company, which will lead to an increase in the utilization rate of machine time;

- transition to the manufacture of products with a higher level of added value;

- a general increase in production efficiency by increasing labor productivity, eliminating auxiliary fixed assets that are no longer needed

In addition, other indicators are calculated: capital intensity, the inverse indicator of capital productivity, characterizes the cost of production fixed assets per 1 rub. products.:

Femcapacity = Fsr. / VP (8),

In the process of analysis, the dynamics of the listed indicators, the implementation of the plan in terms of their level, the comparison of indicators in the analyzed years compared with the indicators in the base year are studied, inter-farm comparisons are carried out. For the purpose of a deeper analysis of the effectiveness of the use of fixed assets, the return on assets is determined for all fixed assets. To calculate the influence of factors on the increase in capital productivity of equipment, the method of chain substitutions is used. In this analysis, the values ​​of the analyzed year are gradually put into the formula instead of the values ​​of the base year and the influence of each of the factors is calculated: the structure of the equipment, all-day downtime, shift ratio, intra-shift downtime, average hourly output. The next stage of the analysis is the determination of capital-labor ratio (analysis of the provision of the enterprise with fixed assets). This indicator is defined as the ratio of the average annual cost of all fixed assets to the average number of employees in the enterprise:

Fvoor.=Fsr./ P (9),

where P is the number of employees at the enterprise (includes all workers, engineers and administrative staff). This indicator shows the cost of fixed assets attributable to one worker.

To calculate the efficiency of the use of fixed assets, the profitability indicators of fixed assets are calculated:

Overall profitability (P0, %)

P0 \u003d 100 x Pb / (Cav.g + Co.s),

where Pb is the total (balance sheet) profit; Ср.г - the average annual cost of fixed production assets; Сo.с - the average annual cost of working capital.

Estimated profitability (Рр)

PP \u003d 100 (Pb - Pp) / (Cav.g + Co.s),

where Пп - various payments and taxes from the total profit.

The indicator of profitability of production, in addition to the efficiency of the use of fixed assets, also shows the efficiency of the use of working capital.

Question

Identification and analysis of reserves and factors that determine the main directions for improving the efficiency of healthcare organizations

— increasing the autonomy and independence of healthcare organizations:

continuation of the phased transfer of medical organizations to enterprises on the right of economic management, including the phased introduction of international financial reporting standards in healthcare organizations;

providing public health organizations with greater autonomy in making management decisions;

rational delineation of functions and powers between healthcare entities;

development of an effective algorithm for interaction between healthcare and social security organizations;

ensuring continuity in the management of the patient at all stages (stages of medical services);

— stimulating the development of the private sector:

systematic improvement of the relevant regulatory and methodological framework for the development of the private sector in health care;

elimination of unnecessary administrative barriers;

development and implementation of mechanisms for supporting and developing socially oriented corporate medical networks and organizations interested in providing free medical care (guaranteed volume of free medical care), implementing state programs for disease prevention and promoting a healthy lifestyle of the population,

including the adoption of measures to attract private health care providers to fulfill the state order;

phased implementation of the public-private partnership program

in healthcare, including the transfer of fixed assets (buildings, equipment) to trust management and long-term lease to private medical organizations;

— improvement of personnel policy in healthcare organizations:

development of a concept for the development of human resources for health care, including planning for the development of human resources in the health care system and mechanisms for increasing the efficiency of its use;

expanding the practice of forming targeted orders of local executive bodies for the training of healthcare professionals;

provision and creation of a regulatory framework for attracting managers

with economic education in the management of healthcare organizations and training them in management in healthcare;

improving the system of remuneration of medical workers;

raising the social status and prestige of the profession of medical workers, including through mass information campaigns

in support and coverage of the professional activities of doctors;

development of republican and regional programs for the professional development of doctors, including the development of institutions of professional reputation and professional competition;

increasing the role and support of professional associations of medical workers (professional NGOs);

development and implementation of mechanisms for the social protection of medical workers, including the preparation of a social package for them;

development and implementation of a system of preventive measures

for medical workers in case of a threat of the spread of quarantine and especially dangerous infections;

— development of informatization in health care:

further improvement and implementation of the UHMIS (Unified Health Information System);

implementation of clinical algorithms, protocols and other standards in the UHMIS.