Abstract
Hospital Financing: Clinical Budget Holding to Increase Efficiency in Provincial Hospitals Inpatient care is the most expensive health expenditure in almost all countries with limited measures to improve efficiency. This action research aimed to test the model to increase hospital efficiency. Under the assumption that if clinical directorates were given the authority to manage clinical budget, efficiency was likely to occur. Three provincial hospitals were recruited to this action research, a purchaser-provider model was created. This model transferred management responsibility from the hospital director to the clinical directorates. They played the purchaser role by holding their own clinical budgets. Pharmacy, radiology, laboratory and operating theatre acted as providers in this model. It was expected that clinician behaviours would change, because if they could save their budget in treating their patients, the unspent money would be retained and could be used for their development plan. However, the quality of care should not be compromised by this quasi-experiment. Firstly, the incentives of clinical departments to be efficient focused mainly on financial measurement; i.e. the expected budget by diagnosis related group of each department and cost accounting data versus the actual spending by billing data. After a year of implementation, the clinicians argued that other indicators should be taken into consideration because of the weakness of financial data. Complementary data included lengths of stay compared by DRG, physician workload by length of stay and DRG relative weight. This action research proved that the measurements for hospital efficiency were complex. Quality audit had to be in place but the activity was still too early to be a measurement that could link to performance of each department. Client satisfaction had not been measured in this study since the individual clients were too far from the tested model. Physicians accepted that DRG was a good measure of efficiency but had to be complemented with other information. Findings of this research should be used to develop management model in the decentralised autonomous hospital. Clinical directorates need more training in searching for hospital efficiency and manage the changes. Information systems must give accurate and comprehensive aspects of efficiency as well as quality.
