CONTENTS

ACRONYMS AND ABBREVIATIONS...... iii

EXECUTIVE SUMMARY...... v

1.THE ASSIGNMENT...... 1

1.1Background...... 1

1.2Objectives...... 1

1.3Findings...... 2

1.4Recommendations...... 4

1.5Overview of Field Methods and Activities...... 6

2.FACILITY DESCRIPTION...... 9

2.1Infrastructure...... 9

2.2Management and Organizational Structure...... 9

2.3Overview of Trends in Service Utilization and Finance...... 11

3.SUMMARY OF PREVIOUS FIELDWORK AND OTHER CONSIDERATIONS.....13

3.1Previous Technical Reports and Fieldwork ...... 13

3.2Constraints, Challenges, and Opportunities...... 14

4.FIELDWORK...... 15

4.1Budget Breakdown...... 15

4.2Cost Accounting...... 17

4.3Performance Reporting...... 19

4.4Provision of Internal Control Technical Assistance and Recommendations for

User Fee Management...... 19

ANNEXES

A.Organizational Chart...... 21

B.Baseline Data...... 31

C.Departmental Costing Tool Kit...... 39

D.RVU Computation Worksheets...... 65

FIGURES

1.Flowchart of Field Activities...... 8

2.Total Visits to Polyclinic No. 2, 1992-1995...... 11

TABLES

1.Employee Mix by Department...... 10

2.Staffing Mix...... 10

3.Visits to Polyclinic No. 2, 1992–1995...... 11

4.Sources of Funds at Polyclinic No. 2, 1992–1995...... 12

5.Trends in Actual Expenditures at Polyclinic No. 2, 1992–1995...... 12

6.Departmental Expense Breakdown of the Global Budget at Polyclinic No. 2, 1995.....13

ACRONYMS AND ABBREVIATIONS

ABCActivity Based Costing

BUDBudget

CACost Accounting

DIRDirect Costs

FIXFixed Costs

IDS Intensive Demonstration Site

INDIRIndirect Costs

NISNew Independent States

PERPeriod (Time)

QTYQuantity

RVURelative Value Unit

UKRUkraine

VARVariable Costs

VOLVolume

ZRPZadravReform Program

EXECUTIVE SUMMARY

The fundamental mission of the fieldwork for this assignment was to assist Polyclinic No. 2 in L’viv, Ukraine. The assistance was aimed at enhancing the polyclinic management staff’s decision-making capabilities regarding strategies for efficient, effective delivery and financing of health care services. Some of the more significant strategic issues currently of concern are detailed below; all represent opportunities for the polyclinic.

  • User fee implementation, pricing, management, and control;
  • Departmental efficiency and effectiveness;
  • Investment and divestment decisions;
  • Physician and nurse analyses, including staffing mix;
  • Private departmental contracts;
  • Facility planning and control;
  • The creation and promotion of new clinical initiatives and protocols to optimize health care access and delivery (clinical pathways); and
  • The management of pending (new) health care financing methods at the oblast level.

The specific field activities that supported these strategic issues involved three major initiatives: (1) the breakdown of global facility-level budgets into departmental budgets for improved responsibility-centered management; (2) the creation of an underlying departmental cost accounting structure to support more factual decision making about such issues as pricing, departmental management, and gross productivity measurement; and (3) the introduction of broad but internationally accepted internal control guidelines and policy concepts for promoting the effective control of assets such as cash and medicine inventories and the procedural aspects of user fee management. At the conclusion of the fieldwork, all of these activities were implemented.

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