ＨＯＭＡＳ（国立大学病院管理会計システム）による救急医療部門の経営分析

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  • Profit and Loss Analysis for a Tertiary Emergency Care Facility with HOMAS (Universal Hospital Management Accounting System)

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An accurate economic analysis is necessary to improve the profitability of the emergency department (ED) in Japanese hospitals. We performed an actual financial analysis for a tertiary emergency care facility of a local university hospital with HOMAS (Universal Hospital Management Accounting System), which has recently been developed by the National University Corporation. The study analyzed outpatients and inpatients of the ED in Miyazaki Medical College Hospital during a one-year period since April 2004. Thirty-four revenues and 317 costs were estimated by conducting a department-level activity with HOMAS, and the profit and loss analysis was based on a break-even analysis. The costs were divided into variable costs (18 material costs) and fixed costs (the other costs). A time-study research of all the workers excluded any costs that were related to education and research from labor costs. The total number of outpatients and inpatients in the ED were 1, 544 and 435, respectively, and the unit prices of an outpatient and inpatient were \12, 739 and \55, 809, respectively. The ratios of revenues versus costs were 1:3.4 for outpatients and 1:1.2 for inpatients. The marginal profit rates for outpatients and inpatients were 63.1% and 53.2%, respectively. The break-even analysis showed that a daily increase of 17 outpatients or 4 inpatients would cover all the deficits. Reducing the costs was considered ineffective because a 1% reduction of the major costs would produce less than 1% profits. Despite relatively high unit prices and relatively low labor and material costs, the ED incurred significant deficits. The deficits were attributed mainly to the sizable equipment costs for outpatients and the shortage of patients. The best strategy appears to be increasing the number of outpatients by extensively accepting primary care patients. HOMAS is a useful tool for determining the profits or losses in emergency care facilities and as a means to improve their profitability.

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