مدیریت مالی بهداشت-مراقبت در یک محیط در حال تغییر

Concerns over escalating health-care costs have brought about significant changes in the way health-care organizations and professionals are compensated for their services. Capitation, the payment of a fixed fee to health-care providers in exchange for providing medical care when it is needed, has been a significant element of change in the health-care industry. The purpose of this paper is to propose a framework for the evolution of management accounting systems in a changing health-care environment. This framework suggests that the role of activity-based costing, life cycle costing, and value chain analysis becomes increasingly important as the payment for health-care services moves from fee for service reimbursement to capitation arrangements between insurance companies and health-care providers. Health-care organizations that design and implement accurate costing and evaluation systems will enhance their ability to compete successfully in this rapidly changing environment. Total health-care expenditures between 1980 and 1994 increased 400% from $250 billion dollars to over $1 trillion (Standard and Poors, 1995). In response to escalating health-care costs, the health-care industry, led by insurance companies, physicians' groups, and hospitals, has established health maintenance organizations (HMOs) and other integrated delivery systems. Typically, these health maintenance organizations enter into capitation agreements with participating physicians, and/or hospitals, thereby, providing an essentially fixed revenue stream in exchange for some form of guaranteed care for the covered group.

As competitive pressure increases and time to market compresses, companies are outsourcing some design activities to more professional organizations and paying more attentions to core design activities for shortening the cycle time of PD process. At the same time, development activities of complex products are increasingly undertaken by multidisciplinary team members from geographically distributed departments in a virtual and collaborative environment [1]. And modern product structure is increasingly complex and PD process presents the trend of integrating, networking and distribution [2]. Thus, PD process will be more strongly time-oriented and collaborative, while still focusing on cost and quality. As a result, how to better manage and enhance PD processes to cater for various customer requirements becomes a core issue for each single manufacturing enterprise. The PD process can be regarded as an organized group of related design activities involving project initiation, task assignment, product design, process design, etc. Traditionally centralized and sequential product design, planning and scheduling activities are inadequate to respond to the dynamic variations in new PD cycles [3]. Iteration and overlapping of design activities are the fundamental characteristics of complex PD process [4]. Iteration usually leads to rework risk [5], while overlapping activities usually impact project duration. Iteration implies redoing or revising the related design results, which makes the PD process more complex due to the coupled and intermixed activities. Overlapping involves the concurrent execution of two successive activities and allows the second activity to begin before the first one is finished. Overlapping activities also increase communication and excessive information exchange [6]. It is well known that good collaborative and concurrent performance can help to achieve shortened project duration and reduced costs. However, the downstream activity has to iterate to accommodate changes throughout the iteration process, which will lead to additional time at a small amount of rework cost. In this way, the activity sequence of PD determines the development cycle time and cost to certain extent. In addition, overlapping between activities is a good strategy to reduce total project duration. However, the development cost is added because of reworks of downstream activity caused by overlapping with dependent upstream one. Therefore, how to optimize the PD process to reduce the rework delay time and added cost of development activities and improve its concurrent and collaborative capability amongst distributed cooperative members is an important issue. Consequently, an analytical and optimal model of the trade-off between the total project duration impacted by iteration and overlapping and the total development cost is needed in PD. The remainder of this paper is organized as follows. The next section reviews the relevant literature related to process optimization of PD. The problem description and mathematic model of process optimization of PD are developed in Section 3. Section 4 details the proposed hybridization of PGA with VNS to approximate the Pareto optimal solutions. An application case of a LED module development process in an optoelectronic enterprise is demonstrated in Section 5 and conclusions are given in Section 6.

Overlapping and iteration between activities are basic properties in the complex PD process. It is highly desired to obtain the optimal sequencing of the activities for shortening PD project duration and cost. To enhance the performance and efficiency of development process, this article proposes a process optimization model to capture the time characteristics and cost risks due to overlapping and complex interaction in PD processes. In terms of the fact that minimization of time is not synonymous with minimization of cost, we apply Pareto approach to obtain the optimal solution set. So a novel PGVNS method is proposed to approximate the Pareto optimal solutions of the bi-objective process optimization problems. The method is demonstrated with an example from a LED module PD process in optoelectronic enterprise. Simulation results of two different problems indicate that the performances of the proposed approach are better than that of NSGA-II. Moreover, the proposed process model considers overlapping and iterations, which can help project managers to plan and improve the PD process. In consideration of collaboration performance of PD process, there still exists many challenges and research work to do. Therefore, as further research, the following can be considered. First, how to construct collaboration performance measures of PD process, and the tradeoff among project duration, cost and risk. Second, we will consider integrating optimization and simulation algorithm into a decision support system to optimize the activity sequence that uses the variance of collaboration, duration and cost as an objective and evaluate the performance of process from a systematic viewpoint.