Agenzia Giuffrè Francis Lefebvre di Chieti e Pescara

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DATA PUBBLICAZIONE:
MARZO 2023

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THE COST OF MEDICAL AND NURSING EDUCATION

MANAGERIAL CHALLENGES AND POLICY IMPLICATIONS

CURATORI: BRUSATI LUCA

COLLANA: COLLANA DI RICERCHE AZIENDALI - SEZIONE STUDI E RICERCHE

CASA EDITRICE: GIUFFRÃ¨ FRANCIS LEFEBVRE S.P.A.

ANNO EDIZIONE: 2023

PAGINE: XIV - 129

ISBN 9788828837381

CODICE GIUFFRÈ: 024214767

CATEGORIE: CANDIDATO A CONCORSI -

MATERIA: ECONOMIA E AZIENDE

AREA DI INTERESSE: ECONOMIA E AZIENDE

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Il profilo di competenze di medici e infermieri gioca un ruolo essenziale nellâ€™assicurare la qualitÃ  dellâ€™assistenza sanitaria; se perÃ² Ã¨ ormai prassi consolidata valutare altre componenti della spesa in termini di rapporto tra costo ed efficacia, questo criterio trova scarsa applicazione agli investimenti nella formazione del personale sanitario. Un ostacolo importante alla corretta valutazione di questo rapporto Ã¨ la difficoltÃ  nello stimare i costi di tale formazione: i processi educativi, infatti, in larga misura si svolgono in contemporanea allâ€™attivitÃ  di ricerca clinica e allâ€™erogazione di servizi assistenziali. Il volume Ã¨ il risultato di una ricerca sul costing della formazione medica ed infermieristica commissionata dallâ€™Organizzazione Mondiale della SanitÃ  e finanziata dalla Commissione Europea. Dopo aver approfondito lo stato dellâ€™arte della letteratura internazionale in materia di costing della formazione del personale sanitario, il volume presenta i risultati di uno studio pilota condotto su tutte le istituzioni formative della Repubblica di Moldavia, e sulla base di tali risultati discute la valenza informativa dei dati di costo, sia per le scelte di politica sanitaria che per le decisioni di management delle organizzazioni che formano medici e infermieri.

TABLE OF CONTENTS
TABLE OF CONTENTS
List of abbreviations .......................................... XI
List of tables and exhibits ...................................... XIII
INTRODUCTION................... 1
Chapter 1
THE COST OF HEALTH PROFESSIONALSâ€™ EDUCATION
BETWEEN POLICY AND MANAGEMENT
1.1. Global challenges in health professionalsâ€™ education . . . . . . . . . . . . . . . 7
1.2. The economic evaluation of health professionalsâ€™ education . . . . . . . . . . 10
1.3. Some important reminders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.3.1. Basic concepts about costs and costing. . . . . . . . . . . . . . . . . . . 12
1.3.2. Costing joint outputs: education, research and patient care . . . . 15
1.4. Why the Republic of Moldova? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Chapter 2
COSTING HEALTH PROFESSIONALSâ€™ EDUCATION:
A LITERATURE REVIEW
2.1. Objectives and methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.2. Technique A: top-down costing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.3. Technique B: micro-costing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.4. Technique C: step-down costing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
2.5. Technique D: differential costing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.6. Statistical techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
2.7. Advantages and disadvantages of different costing techniques: a summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
IX
TABLE OF CONTENTS
X
Chapter 3
HEALTH PROFESSIONALSâ€™ EDUCATION
IN THE REPUBLIC OF MOLDOVA
3.1. Brief outline of the health system of the Republic of Moldova . . . . . . . . 41
3.1.1. Demographic and epidemiological situation . . . . . . . . . . . . . . . 41
3.1.2. Organization and governance . . . . . . . . . . . . . . . . . . . . . . . . . 42
3.1.3. Financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
3.1.4. Provision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
3.1.5. Human resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.1.6. Health system reforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3.2. Organization of health professionalsâ€™ education . . . . . . . . . . . . . . . . . . 51
3.2.1. Education of medical doctors . . . . . . . . . . . . . . . . . . . . . . . . . 51
3.2.2. Education of nurses and allied health professionals . . . . . . . . . . 57
3.2.3. Continuing education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
3.3. Financing of health professionalsâ€™ education. . . . . . . . . . . . . . . . . . . . . 67
3.3.1. Budgeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
3.3.2. Financial management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 4
COSTING HEALTH PROFESSIONALSâ€™ EDUCATION
IN THE REPUBLIC OF MOLDOVA
4.1. Objectives and methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
4.1.1. Research strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
4.1.2. Baseline data collection patterns . . . . . . . . . . . . . . . . . . . . . . . 78
4.2. Cost of educating medical doctors . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
4.3. Cost of educating nurses and allied health professionals . . . . . . . . . . 96
Chapter 5
USING COSTS FOR DECISION-MAKING
IN HEALTH PROFESSIONALSâ€™ EDUCATION
5.1. Better cost information for better policies . . . . . . . . . . . . . . . . . . . . . . 103
5.2. Should the number of medical and nursing graduates be increased?. . . . 108
5.3. Suggestions for the future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
5.3.1. Monitoring of resource consumption . . . . . . . . . . . . . . . . . . . . 112
5.3.2. Pricing of health professionalsâ€™ training . . . . . . . . . . . . . . . . . . 113
5.3.3. Definition of funding mechanisms for educational institutions . . 114
5.4. Final remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119