Health care billing

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The health cost accounting is both a tool for cost analysis as well as a planning tool for future action. The costs are first identified and characterized. The aim of health cost accounting is to include the success factor employee health ( human capital ) in controlling. On the one hand, sick employees can only achieve part of the performance of a healthy employee ( presentationalism ) or are temporarily not available to add value (absence costs). On the other hand, there are employees who do not show up for work although they are able to do so ( absenteeism ).

The resulting direct and indirect costs should be recorded in the company to enable optimal planning, control and documentation.

need

The shortage of skilled workers caused by the consequences of demographic change means that employees will in future be employed longer than before. The resulting need for operational measures to maintain health and promote health for employees is undisputed. However, the profitability of these measures is difficult to assess. The reason for this is, in particular, the lack of cost consideration in this area.

Structuring of health costs

Direct health costs can be divided into costs that arise for the restoration, maintenance and promotion of employee health in a company and costs that are caused by deviations in the state of health of employees from a certain level of health.

A distinction is made between costs for the occupational health and safety system and follow-up costs. While follow-up costs are always the costs of deviating from a certain level of health, the costs of the occupational health and safety system are made up of both the costs of maintaining health and parts of the deviation costs. So-called illness or accident avoidance costs can be assigned to the costs of compliance, while illness and accident costs can be clearly classified as deviation costs. The testing costs, which can be assigned to both groups, are an exception.

Cost types

Direct health costs are the following:

Sickness and accident avoidance costs

  • Occupational health and safety personnel costs
  • First aid costs
  • Costs for ergonomic measures
  • Health premiums
  • External service costs (e.g. training, health measures)
  • Cost of capital
  • Property, plant and equipment costs (e.g. depreciation and interest for safety equipment, protective clothing)
  • Costs for measures to improve fitness including monetary incentives (e.g. grants to employees for courses)
  • Other (e.g. employee surveys)

Subsidies of any kind are to be deducted from these costs.

Testing costs

Inspection costs arise on the one hand for regular checks (e.g. protective clothing, safety-relevant information, state of health, etc.) and on the other hand to clarify the cause of a work-related accident or illness. As soon as they meet certain prerequisites, companies are obliged to take measures to maintain or protect health in accordance with Sections 1 - 7 of the Occupational Safety and Health Act. This also includes the provision of company medical care. This not only incurs costs for setting up a medical center and the working hours of the doctor, but also costs for special occupational medical care. Examples are:

  • Personnel costs for the safety specialist or the employed company doctor
  • External services (e.g. costs for external safety specialists or company doctor)

Follow-up costs of accidents and illness

They count towards the costs of deviating from a certain level of health as well as the follow-up costs in general, since they only arise as a result of a work-related accident or illness (deviation from the desired state of health). Examples for this are:

  • Continued payment of wages in the event of illness
  • Costs for operational integration measures (management costs)
  • Reorganization costs
  • Costs for compensatory measures due to absence (use of other employees, temporary workers, etc.)
  • Working hours of other employees (e.g. management costs)
  • Costs for the repair of accidental damage (e.g. on machines)
  • Replacement costs
  • Costs for loss of added value (including downtime)
  • Court costs, fines etc.
  • Insurance and contributions
  • Presenting costs

Indirect health costs are incurred in particular for possible image loss, fluctuation or loss of quality and can only rarely be reliably determined.

Design requirements

  • Information relevance: (in terms of health relevance), d. H. the mapping of all determinable, relevant information relating to health
  • Complexity reduction: availability of all necessary information, only consideration of the information relevant to the decision
  • Up-to-dateness: Due to the dynamic nature of the required data, up-to-dateness is important
  • Simplicity: enables the application without special knowledge and considerable training effort
  • Clarity & structure: promote the ability of the decision-makers concerned to react quickly
  • Completeness & accuracy: the coverage of all aspects of the respective facts ensures the quality of the decision-relevant data and thus the quality of the decision
  • Profitability: it must always be ensured that the costs of designing and carrying out a health cost accounting do not exceed the benefits from the additional information generated.

How to implement it

  • Analysis of costs incurred in the past, conclusion on the probability of future occurrence, relevance consideration
  • Identification of main cost items, assignment of the individual costs to cost groups, classification according to cost types and centers
  • Determination of the actual and plan values ​​(calculation rules)
  • Differentiation between clearly measurable (e.g. continued payment of wages) and costs to be estimated (e.g. presenter costs)
  • Attention to costs that are difficult to observe (e.g. presentation costs)
  • Comparison with average values ​​(e.g. the industry)
  • Deriving conclusions (importance of the costs for value creation, etc.)
  • Consideration of how the determined costs relevant to added value can be influenced: z. B. Promoting the health of employees leads to lower follow-up costs

Examples of costing

First aid costs

According to Section 10 of the Occupational Safety and Health Act , companies must name, equip and qualify first aiders. The scope of these measures depends on the number of employees. The direct training costs are usually borne by the employers' liability insurance association. However, the company still incurs costs from the absence of the respective employees for the period of training / training. These can be estimated in a simplified way using the “lost” working time multiplied by the average hourly rate. The planning of these costs is usually based on estimates based on empirical values ​​and requires a list of the training / advanced training requirements for first aiders.

Calculation formula plan / actual:

PK EH = (GrKT × GrK Anz + AfK Anz ) × tAZ + average StS

PK EH = first aid personnel costs
GrKT = number of days of the basic course
GrK Num = number of participants of the basic course
AfK Anz = number of participants in refresher courses
tAZ = daily working hours
StS = hourly rate

Personnel costs for the safety specialist or the employed company doctor

Section 1 of the Occupational Safety and Health Act obliges companies to appoint a company doctor. Depending on the size of the company, regular occupational health care with fixed working times must be guaranteed. General occupational medical examinations are to be counted towards the time the doctor is on duty, special occupational medical (preventive) examinations are not. On the one hand, the company incurs costs for the establishment and operation of a medical center and, on the other hand, costs for the services of the company doctor, which cannot be offset against his working time. These costs can be easily and reliably determined using the accounts with the company doctor. Cost planning, however, is more difficult. On the one hand, costs for the contractually regulated services can be forecast in detail, but on the other hand, additional costs are subject to various influences. Since these are mostly costs for preventive measures, no references to sickness rates or the like can be made. For this reason, planning is only possible on the basis of empirical values ​​and the future orientation is therefore questionable.

Continued payment of wages in the event of illness

According to § 31 and § 91 Clause 1 of the Remuneration Act, an employee who is ill through no fault of his own is entitled to continued remuneration for a period of up to six weeks. Continued payment of remuneration can be recorded as a separate cost type and can therefore be reliably determined. For cost planning, however, it is necessary to set a quota plan for the sick days. The estimate of this sickness rate should be made excluding employees with long-term illnesses, since in these cases the health insurance companies bear the costs of continued remuneration. The planned costs can finally be determined by multiplying the remuneration with the sickness rate.

Calculation formulas:

ACTUAL: Value from
ACTUAL cost accounting PLAN: EKf PLAN = E PLAN × KQ PLAN

EKf PLAN = continued payment in the event of illness
E PLAN = fee (plan value)
KQ PLAN = sickness rate (planned value)

Costs for operational integration measures

Long-term sick employees who return to work after recovery usually require separate reintegration measures. With the aim of restoring the person's ability to work and preventing a new illness, return interviews are held and improvement measures are initiated at the workplace. In particular, personnel costs are incurred for the duration of the integration talks. These can be reliably determined using the recorded call duration. A plan quota for long-term sick people should be included to determine plan costs. Furthermore, based on experience, it can be estimated how many employees use the opportunity for such a conversation. This factor should also be included in the determination of the planned costs in this area.

Calculation formula:

With

K EgG = costs of integration interviews
K RkG = costs for return calls
StS = hourly rate
MA Num = number of participating employees
D = duration of the conversation
G Num = number of calls made

Presenting costs

Employees who work in the company despite illness also generate costs. Reduced performance results in a loss of added value for the respective company. Since the reduction in performance is difficult to observe / measure, problems arise when determining costs. The most reliable way is the approximate determination using the Stanford formula. Investigations within the framework of the application of the Stanford Presenteeism Scale showed that around 20% of all employees go to work despite being ill. Your average reduction in performance is 25%. Exact values ​​can be determined by a combination of the Stanford Presenteeism Scale with an employee survey. This improves the quality of the values ​​and thus also the estimate of the presenter costs.

Calculation formula:

MA Pre = MA total × L Ant
K Pre = MA Pre × average YG × L Min

MA Pre = number of employees in presenterism
MA Total = total number of employees
L Ant = factor for the proportion of employees with reduced performance (e.g. 20 percent)
K pre = presentational costs
JG = annual salary
L Min = factor for the reduction in performance (e.g. 25 percent)

Results

The analysis of 15 medium-sized companies as part of the BMBF project PAGS Monitor has shown that in most companies the main component of health costs is caused by consequential disease costs as a result of deviations in the state of health. These follow-up costs are much higher than the investments that would improve the state of health and thus avoid deviations. This means that through precise knowledge of health costs, targeted measures can be taken to promote health, which as a result increase the added value of a company.

literature

  • B. Badura, Schröder, H., Vetter, C .: Absence Report 2008 - Company Health Management: Costs and Benefits. Berlin 2009.
  • AG Coenenberg , TM Fischer, T. Günther: Cost accounting and cost analysis. 6th edition. Stuttgart 2007.
  • Fürstenberg Institute (Ed.): Psychosocial health for your company's success. Hamburg 2007.
  • T. Günther, C. Albers, M. Hamann: Key figures for health controlling. In: Journal for Controlling and Management. 53rd vol., H. 6, 2009, pp. 367-375.
  • T. Günther, M. Hamann, T. Eisoldt, A. Kahl: Health cost accounting . 2011, pp. 668-676.
  • D. Hahn, H. Hungenberg: PuK - value-oriented controlling concepts. 6th edition. Wiesbaden 2001.
  • P. Hemp: Sick at work. In: Harvard Business Manager. 27. Vol., H. 1, 2005, pp. 47-60.
  • R. Harmful: Occupational medical check-ups. Straelen 2009.
  • A. Töpfer: Business administration - application and process-oriented basics. Berlin 2005.

Individual evidence

  1. ^ T. Günther, C. Albers, M. Hamann: Key figures on health controlling. In: Journal for Controlling and Management. 53rd vol., No. 6, 2009, p. 388.
  2. ^ AG Coenenberg, TM Fischer, T. Günther: Cost accounting and cost analysis. 6th edition. Stuttgart 2007, p. 22.
  3. B. Badura, H. Schröder, C. Vetter: Absence Report 2008 - Company Health Management: Costs and Benefits. Berlin 2009, p. 65ff.
  4. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: Health cost accounting - implementation in a company in the automotive supplier industry. In: Controlling - magazine for success-oriented corporate management. 23rd vol., H. 12, 2011, p. 668.
  5. ^ P. Hemp: Sick at work. In: Harvard Business Manager. 27. Vol., H. 1, 2005, p. 50.
  6. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 668f.
  7. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 670ff.
  8. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 670ff.
  9. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 670ff.
  10. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 670ff.
  11. D. Hahn, H. Hungenberg: PuK - value-oriented controlling concepts. 6th edition. Wiesbaden 2001, p. 77.
  12. ^ A. Töpfer: Business administration - application and process-oriented basics. Berlin 2005, p. 1165.
  13. D. Hahn, H. Hungenberg: PuK - value-oriented controlling concepts. 6th edition. Wiesbaden 2001, p. 84.
  14. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 670ff.
  15. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 671f.
  16. R. Schädlich: Occupational medical check-ups. Straelen 2009.
  17. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 670.
  18. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 673.
  19. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 673.
  20. ^ Fürstenberg Institut GmbH (ed.): Psychosocial health for your company's success. Hamburg 2007, p. 26ff.
  21. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 674.
  22. ^ T. Günther, M. Hamann, T. Eisoldt, A. Kahl: health cost accounting . 2011, p. 675.
  23. www.dielunge.info/index.php?id=18