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A Study of Philippine Hospital Management Administrative Systems

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A Study of Philippine Hospital Management Administrative Systems A Service of Leibniz-Informationszentrum econstor Wirtschaft Leibniz Information Centre Make Your Publications Visible. zbw for Economics Avestruz, Fred Working Paper A Study of Philippine Hospital Management Administrative Systems PIDS Discussion Paper Series, No. 1995-16 Provided in Cooperation with: Philippine Institute for Development Studies (PIDS), Philippines Suggested Citation: Avestruz, Fred (1995) : A Study of Philippine Hospital Management Administrative Systems, PIDS Discussion Paper Series, No. 1995-16, Philippine Institute for Development Studies (PIDS), Makati City This Version is available at: http://hdl.handle.net/10419/187290 Standard-Nutzungsbedingungen: Terms of use: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Documents in EconStor may be saved and copied for your Zwecken und zum Privatgebrauch gespeichert und kopiert werden. personal and scholarly purposes. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle You are not to copy documents for public or commercial Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich purposes, to exhibit the documents publicly, to make them machen, vertreiben oder anderweitig nutzen. publicly available on the internet, or to distribute or otherwise use the documents in public. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, If the documents have been made available under an Open gelten abweichend von diesen Nutzungsbedingungen die in der dort Content Licence (especially Creative Commons Licences), you genannten Lizenz gewährten Nutzungsrechte. may exercise further usage rights as specified in the indicated licence. www.econstor.eu Philippine Institute for Development Studies A Study of Philippine Hospital Management Administrative Systems Fred Avestruz DISCUSSION PAPER SERIES NO. 95-16 The PIDS Discussion Paper Series constitutes studies that are preliminary and subject to further revisions. They are be- ing circulated in a limited number of cop- ies only for purposes of soliciting com- ments and suggestions for further refine- ments. The studies under the Series are unedited and unreviewed. The views and opinions expressed are those of the author(s) and do not neces- sarily reflect those of the Institute. Not for quotation without permission from the author(s) and the Institute. June 1995 For comments, suggestions or further inquiries please contact: The Research Information Staff, Philippine Institute for Development Studies 3rd Floor, NEDA sa Makati Building, 106 Amorsolo Street, Legaspi Village, Makati City, Philippines Tel Nos: 8924059 and 8935705; Fax No: 8939589; E-mail: [email protected] Or visit our website at http://www.pids.gov.ph A STUDY OF PHILIPPINE HOSPITAL MANAGEMENT AND ADMINISTRATIVE SYSTEMS PIDS Project No. DOH / 91-92 / 05 (Final Report) October 30, 1994 Fred S. Avestruz, MBA, Ph.D. Asian Institute of Management TABLE OF CONTENTS Chapter Page 1 INTRODUCTION ...........................................................................1 1.1 Objectives of the Study .................................................. 1 1.2 Conceptual Framework of Hospital Management ................ 2 1.3 The Hospital in the Philippine Health Care System ................. 3 1.3.1 The Philippine Health Care System ..................... 5 '_1.3.2 Role of Hospitals .............................................. 7 1.3.3 Hospitals Industry Structure ................................. 15 1.4 Operational Characteristics of Philippine Hospitals ................ 18 1.5 Hospitals in the Case Studies ...................... 2....................... 23 2 EXTERNAL INFLUENCES ON HOSPITAL MANAGEMENT AND PERFORMANCE ................................................ 1 2.1 Market Demand ............................................................... 1 2.2 Networking and Referral System ...................................... 23 2.3 Health Care Financing Programs ........................................ 29 2.4 Technology ................................................................... 31 2.5 Macroeconomic Conditions ................................................. 32 2.6 External Organizations .................................................. 33 2.7 Government Policies ....................................................... 33 2.7.1 General Interventions ..................................... 33 2.7.2 Local Government Code ....................................... 36 2.8 Summary ...................................................................... 37 3 MANAGERIAL DECISIONS AND CONTROL SYSTEMS IN PHILIPPINE HOSPITALS .................................... :....... 1 3.1 Goals ............................................................................... 1 3.2 Decision MAking Processes to Establish a Hospital .............. 10 3.3 Key Hospital Actors ........................................................ 11 3.4 Planning Processes ..................................................................... 15 3.5 Interactions Among Key Hospital Actorss and Decisions Making Processes in Philippine Hospitals ......................... 18 3.5.1 Capital Expenditure Decision ............................ 18 3.5.2 Budget Decisions .................................................. 22 3.5.3 Personnel Decisions ........................................... 23 3.5.4 Pricing Decisions ............................................ 46 3.6 Control System ................................................................ 63 3.6.1 Quality Control ................................................... 63 3.6.2 Financial Control ......................................... 68 3.7 Summary ................................................................... 71 4 TECHNICAL PERFORMANCE OF PHILIPPINE HOSPITAL ............................................................ 1 4.1 Conceptual Background of Hospital Performance Evaluation ............................................................. 1 4.2 Occupancy Rates of Philippine Hospital ...................... 3 4.3 Effectiveness of Treatment of Philippine Hospital .................... 12 4_4 Patient Length of Stay in Philippine Hospitals ..................... 19 4.5 Summary ...................................................................... 19 I 5 FINANCIAL CHARACTERISTICS AND PERFORMANCE OF PHILIPPINE HOSPITALS ......................................... 1 5.1 Financial Characteristics of Philippine Hospitals .......................... 1 5.1.1 Capital Structure ..................................................... 1 5,1.2 Allocation Of Assets ......................................... 2 5.1.3 Pattern of Expenditures ......................................... 9 5.1.4 Pattern of Revenues ............................................. 30 5.2 Financial Performance ...................................................... 33 5,2.1 Liquidity Ratios .................................................. 33 5.2.2 Efficiency Ratios ........................................... 40 5.2.3 Leverage Ratios .......... ..................................... 41 5.2.4 Profitability Ratios ............................................. 41 5.3 Summary ................................................................... 42 1 6 CONCLUSIONS AND RECOMMENDATIONS .......................... 6.1 Characteristics and Problems of Hospital Management and Performance ..................................... 1 6.1.1 Govemement Hospitals ..................................... 1 6.1.2 Private Hospitals ............................................. 2 6.2 Recommendations ......................................................... 3 6.2.1 Private Hospitals .......................................... 3 6.2.2 Government Hospitals ..................................... 3 BIBLIOGRAPHY .............................................................................. B- 1 LIST OF TABLES Table No. Title Page 1.1 Health Facilities to Population Ratio ...................... 1.2 Number of Health Facilities by Region ................ 1.3 Ratio of DOH Facilities to Population ................. 9 1.4 Number of Hospital Beds and Hospital Bed to Population Ratio by Region ........................... ' 10 1.5 Bed to Population Ratio and Health Center to Population Ratio by Region ............................... 11 1.6 Accessibillity of DOH Hospitals .............................. 12 1.7 Number and Percentage of Patients in Government Hospitals by Region ............................................... 13 1.8 Classifictions of Hospitals ..................................... 18 1.9 Actual Bed Capacity of DOH Hospital, by Category and by Region .................................... 17 1.10 Regional Distribution of Member Hospitals by Category .......................................................... ]9 1.11 Distribution of Licensed Hospitals by Level ................. 20 2.1 Ten Leading Causes of Hospitalization ....................... 5 2.2 Number of Cases per Classification ............................ 5 2.3 Nature of Leading Causes of Hospitalization ............ 6 2.4 Average Patient Days of DOH Hospitals by Type of Service and by Type of Hospitals ................... 8 2.5 Number of Patients of DOH Hospital by Type of Service and Type of Hospital .................................. 8 2.6 Ten leading Causes of Morbidity, G2 Hospital Catchment Area ...................................................... 10 2.7 Ten Leading Causes of Mortality, G2 Hospital i Catchment Area ................................................... 11
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