O setor de saúde pública convive com uma constante escassez de recursos combinada com uma necessidade crescente de investimentos em tecnologia e inovação. Portanto, é necessário que os gestores públicos de saúde busquem maneiras de maximizar o uso destes recursos orçamentários escassos. Uma das alternativas é implementar estudos sobre custos, que possibilitem ao gestor exercer o controle, o combate ao desperdício e o planejamento dos investimentos futuros. No entanto, na área governamental, existem outros grupos, além do gestor, que têm interesse em conhecer as informações de custos do setor de saúde. Esses grupos são chamados pela teoria da administração de Stakeholders. Cada stakeholder, tais como médicos, pacientes, fornecedores, sociedade entre outros podem demandar informações distintas de custos. Por este motivo, o objetivo deste trabalho é investigar qual o método de custeio que melhor se adequa as necessidades dos diferentes stakeholders de um hospital público. Para tanto, elaborou-se uma pesquisa bibliográfica que abordasse os métodos de custeio por absorção, custeio variável e custeio baseado em atividades, que são os métodos mais debatidos pela literatura contábil. Dessa forma, com objetivo de responder a questão de pesquisa, o presente trabalho desenvolve um cenário hipotético de um hospital universitário público, no qual estão identificados os seus stakeholders e suas respectivas necessidades de informações de custo. Como resultado das análises, observa-se que cada um destes stakeholders apresenta um método de custeio, ou uma combinação de dois destes, que melhor se adequa as suas necessidades de informação de custos. / The public health sector coexists with a constant shortage of resources combined with a growing need for investment in technology and innovation. Therefore, it is necessary for public health managers to look for ways to maximize the use of these scarce budget resources. One alternative is to implement studies on costs, in a way that the manager is able to take actions to control costs, fighting waste and planning future investments. However, in the governmental area, there are other groups in addition to the manager who have an interest in knowing the information of health sector costs. These groups are called by management theory as Stakeholders. Each stakeholder, such as doctors, patients, suppliers and society, among others may require different information of cost. Therefore, the aim of this study is to investigate what is the cost method that best suit the needs of different stakeholders in a public hospital. In view of that, the study uses a literature that addresses the methods of absorption costing, variable costing and activity-based costing, which are the methods most debated by the accounting literature. Thus, in order to answer the research question, this study develops a hypothetical scenario of a public university hospital, in which its stakeholders and their needs for cost information are identified. As a result of the analysis, it is observed that each of these stakeholders has a costing method, or a combination of two of these, that best suits their cost information needs.

Frente à necessidade de conhecimento dos custos hospitalares, enfermeiros gestores dos Centros de Material e Esterilização (CMEs) têm intensificado a busca por informações úteis e balizadoras de forma a instrumentalizá-los no gerenciamento de custos dessas unidades. Conhecer e implementar o gerenciamento de custos baseado em atividades constitui em alternativa para se adquirir informações precisas e confiáveis. Este estudo exploratório descritivo na modalidade de estudo de caso tem como objetivo a aplicação do Custeio Baseado em Atividades para o gerenciamento de custos em um Centro de Material e Esterilização de um hospital de ensino de capacidade extra, localizado na região noroeste do Estado de São Paulo. A coleta de dados ocorreu durante o ano de 2006 utilizando as técnicas de análise documental, observação direta não participante, grupo focal e questionário. A aplicação do ABC possibilitou o conhecimento dos custos do ciclo/carga de desinfecção química R$ 13,15 e física R$ 27,49 e esterilização por vapor saturado sob pressão R$ 68,30 e por vapor de Baixa Temperatura e Formaldeído Gasoso R$ 555,77. As informações geradas pelo ABC oportunizaram a compreensão do processo gerador de custos e forneceram base para a mensuração de desempenho e melhorias de processos do CME / Due to the need of knowing the hospital costs, sterile processing department (SPD) manager nurses have intensified the search for useful and landmark information attempting to instrumentalize these costs into the cost management of these facilities. Knowing and implementing the cost management based on activities establishes an alternative to acquire accurate and reliable information. This descriptive, exploratory study on the case study modality was undertaken aiming at implementing the Activity-Based Costing (ABC) to the cost management in a Sterile Processing Center (SPD) of a major teaching hospital, located on the Northwestern of São Paulo State. Data were collected throughout 2006. Documentary research techniques, non participant closed observation, and focus group technique were used. The ABC implementation allowed the knowledge of both chemical and physical disinfection cycle/load activity-based costing (R$ 13,15) and (R$ 27,49), respectively; as well as the sterilization by steam under pressure cost (autoclave) (R$ 68,30) and low temperature steam and gaseous formaldehyde Sterilization (LTSF) (R$ 555,77). The information provided by the ABC method have optimized the overall understanding of the cost driver process and laid the foundation to the measurement of performance and improvement in the SPD processes

Esse estudo tem por finalidade contribuir para a discussão e o aprimoramento da gestão econômica e do desenvolvimento de ferramentas de apoio à decisão estratégica para empresas de serviços de saúde suplementar. Com base nos fundamentos teóricos sobre serviços, serviços de saúde suplementar, gerenciamento estratégico de custos e sistemas ABC/ABM, o estudo propõe um modelo de sistema de gestão de custos indiretos em planos de saúde sob a óptica do ABC/ABM, que visa proporcionar aos gestores uma visão ampla sobre o desempenho econômico dos planos e dos clientes. Assim, este estudo pretende colaborar com o desenvolvimento desse setor, que tem sofrido nos últimos anos o impacto da evolução da tecnologia e da medicina, provocando a constante elevação dos custos da assistência à saúde. Com a finalidade de justificar o estudo, o modelo é testado com a sua implementação em uma operadora de planos de saúde, possibilitando a discussão sobre as conclusões obtidas em relação ao problema abordado. / The purpose of this study is to contribute towards the indirect cost management discussion and betterment of supplementary health care services companies as well as to strategic decision supporting tools development. On the basis of the theoretical beddings on services, supplementary health care services, strategic management of costs and ABC/ABM systems, this study proposes an indirect costs management model for health insurance based on the ABC/ABM optics that provide managers a wide vision on the economic performance of medical insurance plans and customers.Thus, this study intends to contribute towards this sector development that has been suffering in the last years the impact of the technology medicine evolution provoking constant rise on health care costs. In order to justify this study, the model is tested by its implementation in a medical insurance operator making possible the discussion about conclusions obtained from the approached problem.

Apresenta uma análise da estimação de custos em sistemas de manufatura utilizando rede de Petri (PN), ferramenta gráfica e matemática para modelagem e simulação. Esta análise permite a apresentação de um sistema aplicável à programação e otimização de processos de fabricação aliadas à estimação dos custos ao longo do processo. Para uma determinada peça, a partir de conceitos sobre custeio de produtos, é proposto um modelo que visa conectar as transições da PN com as informações de custos de produção. O estudo de caso mostra que informações importantes à tomada de decisão podem ser obtidas através do uso de uma metodologia que incorpore planejamento de processos, métodos de custeio e redes de Petri. Finalmente, traz sugestão de um trabalho subseqüente: a partir do modelo proposto, implementar um template no editor/simulador de redes de Petri, Petri Net Tools 2000, capaz de realizar os cálculos necessários para estimativas de custo e fornecer resultados relevantes para um planejamento real. / This work presents a cost estimation analysis in manufacturing systems based in Petri net (PN), which is a graphical and mathematical tool. This analysis allows the presentation of a system, applicable to the programming and optimizing of manufacturing processes joined with cost estimation. A cost model is proposed using concepts of product costing. It seeks for connecting PN transitions to the data manufacturing cost of a certain part. The case study shows that important information to decision support can be found through the use of a methodology which joins process planning, costing systems and Petri nets. There is also a suggestion of a later work: a template implementation, on Petri Net Tools 2000 editor/simulator of PN models, which is able to accomplish the necessary calculations for cost estimates and, to supply important results to a real planning.

Introdução: Os pacientes críticos necessitam de um acesso venoso central (AVC) para realização de terapia intravenosa (TIV) prolongada. Dentre as opções de AVC, o cateter central de inserção periférica (CCIP) vem conquistando espaço, progressivamente, nas organizações hospitalares brasileiras. A passagem de CCIP requer recursos humanos especializados, materiais, medicamentos e soluções específicas tornando-se fundamental a apuração dos custos envolvidos para subsidiar a eficiência alocativa destes insumos. Objetivo: Identificar o custo direto médio (CDM) do procedimento de passagem de CCIP, realizado por enfermeiros, em uma Unidade de Terapia Intensiva Pediátrica e Neonatal (UTIPN). Método: Trata-se de pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único. O procedimento objeto de estudo foi estruturado em três fases: pré-inserção do cateter, inserção do cateter e pós-inserção do cateter. A amostra constituiu-se da observação não participante de 101 passagens de CCIP na UTIPN. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por enfermeiros e técnicos de enfermagem pelo custo unitário da mão de obra direta (mob), somando-se ao custo dos materiais e soluções. A moeda brasileira real (R$), utilizada originalmente nos cálculos, foi convertida para a moeda norte-americana dólar (US$). Resultados: Obteve-se o CDM do procedimento ( ) de passagem de CCIP correspondente a US$ 226.60 (DP=82.84), variando entre US$ 99.03 e US$ 530.71, com mediana de US$ 313.21. O CDM com material, US$ 138.81(DP=75.48), e o CDM com mob de enfermeiro, US$ 78.80 (DP=30.75), foram os valores mais expressivos para a composição do . Os kits de cateteres corresponderam aos itens de maior impacto na composição do CDM com material e de maior custo unitário, com destaque para cateter epicutâneo + introdutor, kit - 2FR/duas vias (US$ 208.82/unidade); cateter epicutâneo + introdutor, kit - 2FR (US$ 74.09/unidade) e cateter epicutâneo + introdutor, kit - 3FR (US$ 70.37/unidade). O CDM com mob da equipe de enfermagem foi mais elevado na Fase 2: inserção do cateter (US$ 43.26 - DP=21.41) e na Fase 1 pré-inserção do cateter (US$ 37.96 - DP=14.89). Houve predomínio do CDM com mob de enfermeiro, especialmente pelo protagonismo dos enfermeiros executantes, US$ 40.40 (DP=20.58) e US$ 34.05 (DP=15.03), respectivamente. Conclusão: Este estudo de caso além de propiciar a mensuração do de passagem de CCIP, conferiu visibilidade aos insumos consumidos na perspectiva de contribuir com o seu uso racional. Favoreceu inclusive a proposição de estratégias visando incrementar a TIV prolongada, por meio do CCIP, e, consequentemente, auxiliar na contenção/minimização de custos e na diminuição de custos intangíveis aos pacientes. / Introduction: Critical patients require central venous access (CVA) for prolonged intravenous (IVT) therapy. Among the AVC options, the peripherally inserted central catheter (PICC) has been progressively gaining a position into the Brazilian hospital organizations. The passage of PICC requires specialized human resources, materials, medicines and specific solutions, being crucial to calculate the costs involved to subsidize the allocative efficiency of these inputs. Objective: To identify the average direct cost (ADC) of the PICC procedure performed by nurses, in a Pediatric and Neonatal Intensive Care Unit (PNICU). Method: This is a quantitative, exploratory-descriptive single-case study. The procedure was arranged into three phases: \"pre-insertion of the catheter\", \"insertion of the catheter\" and \"post-insertion of the catheter\". The sample consisted of the non-participant observation of 101 PICC passages in the PNICU. The average was calculated by multiplying the time (measured) spent by nurses and nursing technicians by the unit cost of direct labor (dl), adding up to the cost of materials and solutions. The Brazilian Real currency (R $), originally used in the calculations, was converted to the US dollar currency (US $). Results: The ADC of the PICC procedure ( )) corresponded to US $ 226.60 (SD = 82.84), ranging from US $ 99.03 to US $ 530.71, with a median of US $ 313.21. ADC regarding material was US $ 138.81 (SD = 75.48), and ADC regarding nurse dl was US $ 78.80 (SD = 30.75) which were the most significant values for the ( ) composition. The catheter kits corresponded to the items with the highest impact in the composition of the ADC regarding material and with a higher unit cost, with emphasis on epicutaneous catheter + introducer, kit - 2FR / two tracks (US $ 208.82 / unit); Epicutaneous catheter + introducer, \"kit\" - 2FR (US $ 74.09 / unit) and epicutaneous catheter + introducer, \"kit\" - 3FR (US $ 70.37 / unit). The ADC regarding dl of the nursing team was higher in Phase 2: \"insertion of the catheter\" (US $ 43.26 - SD = 21.41) and in Phase 1 \"pre-insertion of the catheter\" (US $ 37.96 - SD = 14.89). There was a predominance of the ADC regarding nurse dl, especially due to the leading role of the nurse practitioners, US $ 40.40 (SD = 20.58) and US $ 34.05 (SD = 15.03), respectively. Conclusion: This case study, besides providing the measurement of the PICC passage, allowed visibility to the inputs consumed from the perspective of contributing to its rational use. It also favored the proposition of strategies aimed at increasing the prolonged IVT through PICC and, consequently, to contain / minimize costs and reduce intangible costs to patients.

The diploma thesis is focused on costs, calculation and primarily analysis of calculation systems and formula. The thesis is divided into two main parts – theoretical and practical part. The theoretical part is focused on explanation between financial and management accounting, description of basic terms and expense classification. Attention is given to system of calculation, its items, and calculation formula. Mention belongs to modern access of calculation – ABC. Practical part is focused on company Prefa Brno a.s., which main part of business is production and sale of building products and components. Shortly is mentioned characteristic of company, its history, present, sales and SWOT analysis. The main orientation of diploma thesis is on calculation system of the company, its descrtiption, methods of set-up and anylysis. Closing part of thesis includes summary of basic pieces of knowledge from analysis of calculation formula (system), which is compared with method of target casting, which belongs to modern methods of strategic management accounting. In the last part is given calculation in the case of additional item of material rate and quantification of impacts.

The diploma thesis analyzes detached house created in BIM software. In the practical part was modeled BIM model, which was attributed the Information. Of the exported data was created budget and calculated total cost of building. The part of this work is calculate life-cycle cost and analysis of the most costies parts. The main result of this work is the demonstrace private investors and public procurement the advantages of BIM attitute to projects, Also calculate the price of building and life cycle costs in the studies BIM model can help investor to show how much they will cost of building without investor didn´t invest too much project funds and thus could reconsider the rejection or modification project.

Cette thèse présente la première évaluation économique de la prématurité en France. La prématurité intervient avant 37 semaines d’aménorrhée. Elle est en constante augmentation dans le monde. Si les enjeux de santé publique sont bien identifiés, la prise en charge et les choix collectifs en matière de prématurité comportent des enjeux économiques importants. La première partie de cette thèse présente les enjeux de santé publique de la prématurité et les efforts restant à fournir en matière de prévention en France. Elle conduit ensuite une réflexion économique sur les moyens d’une utilisation au plus « juste » socialement des ressources dédiées à la santé périnatale, dans le contexte d’augmentation des dépenses de santé. Une mesure de la charge collective de la prise en charge de la prématurité est nécessaire et envisagée au moyen d’une étude Cost-Of-Illness. Enfin elle pose le cadre dans lequel l’éthique et l’évaluation économique sont complémentaires. La deuxième partie présente la méthodologie et les résultats de l’étude, consistant à évaluer les coûts directs hospitaliers et extrahospitaliers des naissances prématurées et à terme, dans la première année de vie, du point de vue de l’Assurance Maladie. Les données sont extraites du Système National d’Information Inter-Régime de l’Assurance Maladie. Les résultats montrent l’ampleur des coûts moyens associés à la grande prématurité et une relation inverse et significative entre les coûts moyens et l’âge gestationnel. Cette étude économique invite à la sensibilisation des décideurs publics à la nécessité d’allouer les moyens financiers et humains pour prévenir la survenue de situations critiques associées à la prématurité. / This thesis focuses on a first economic assessment of prematurity in France. Prematurity is defined as occurring before 37 weeks of gestation. It is increasing in France and worldwide. If the issues of public health are already well identified, medical care and collective choices concerning prematurity matters also involve significant economic challenges. The first part of this thesis attempts to present the public health issues of prematurity and highlights the remaining efforts required to provide prevention in France. It then considers economic issues on the use of socially fairer resources dedicated to perinatal health in a context where current health expenditure is rising. Assessment of the collective burden of care for preterm infants is necessary and envisaged by a Cost-Of-Illness study. Finally it presents a framework where ethical and economic considerations are complementary. The second part addresses the methodology and results of the study. The study assesses the hospital and non-hospital direct costs for preterm and term births, in the first year of life, from health insurance point of view. It is based on an extraction of data from the National Heal Insurance Inter-Regime Information System. The results of the study highlight in particular the level of average costs associated with extreme prematurity (before 32 weeks) and demonstrate an inverse and significant relationship between average costs and the gestational age (GA) at birth. This economic study invites awareness of the policy makers about the need to provide financial and human resources to anticipate and prevent critical situations associated with prematurity.

The object of this thesis is the electronization of services in the current tax administrations. The major aim of this paper is an analysis of how IT costs and other variables affect salary costs. Another aim of the work is to describe the differences in the structures of contemporary tax administrations in the OECD countries as well as to outline the current situation and possible future development in the use of electronic services in this area.

The thesis is focused on IS/ICT cost management. The purpose of this thesis is to create an IS/ICT cost model based on the principles of managerial method ABC (Activity Based Costing) for business informatics of selected company. The theoretical part is focused on costs in IS/ICT, their classification and management, with the analyze of the reasons for continuous growth of IS/ICT cost management. A significant part of this section is a characteristic of ABC method and a description of different phases in creation of ABC model. The practical part of the thesis presents a selected company, its business informatics and an organizational structure. Subsequently the current state of IS/ICT cost management is described and analyzed. Based on the analysis and with regard to objectives of the company in the future, a new IS/ICT cost allocation model is designed. For the purpose of calculating and determining of intradepartmental prices for ICT services, a process of allocating and calculating costs is simulated on the new designed model, with the use of current and historical data of the company. At the end of the practical part, the results achieved through the designed model and the results of the current method of allocation and calculation costs are compared.