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Management Accounting System for Hospitals (MASH)

Purpose/Description
The Management Accounting System for Hospitals (MASH) is a software application for tracking and analyzing a health facility's services, resources, and costs. It provides the means for routine management control, the initiation and management of change, and for examining productivity and efficiency. MASH helps make management of resources and services transparent and comprehensible for all parties involved in health service delivery and management.

While MASH is primarily designed for hospitals, it is easily modified to suit any health care delivery setting - ambulatory health care center, family practice association or integrated health system - that is interested in managing its operations in cost-efficient ways.

MASH was initially developed as an Excel workbook built around 12 inter-related spreadsheets. The Excel workbook allows the user to customize the spreadsheets to their individual needs. A fully populated version is provided to demonstrate how a completed workbook looks. The Microsoft Access automated version adopts the same structure as the Excel version with a fully populated version also available. Four of the Excel spreadsheets involve entering primary data while the other eight use data to perform calculations and analysis. The MASH is structured by cost centers such as - organizational units with distinct functions, outputs, technologies, and management targets. A User's Manual is available for use with both the Excel and Access programs.

MASH has a wide potential audience - hospital managers, health regulators and purchasers of care are all potential users – who can employ it for a variety of purposes:
  • Hospital managers who carry out tasks such as: setting realistic and competitive prices; negotiating contracts with purchasers of care; keeping clinical volume and capacity utilization at efficient levels; modeling the cost and revenue impact of structural change; and demonstrating cost and productivity performance to customers, auditors, financing agencies and regulators.
  • Purchasers of care who must compare the performance of different hospitals and make decisions about national funding and selective contracting.
  • Regulators or auditors who have responsibility for evaluating hospital performance and need to assess hospitals according to internal and external norms.
  • Health financing or operations analysts who have responsibility for advising on policies of resource allocation, care purchasing or hospital management.

Application & Results
The Excel version of MASH has been used in Jordan and Eritrea to conduct cost analysis of hospitals. In Eritrea, this was the first time that the Ministry of Health was able to see how much it costs to provide hospital-based care. Services at three hospitals were costed and the unit cost comparisons allowed the Ministry to see differences in efficiency of care delivery and the effects of capacity utilization of the hospitals. The table below shows the overall unit costs of the three hospitals.

Service Pediatric Hospital National Keren Hospital(Regional) Dekemhare Hospital(Community)
Output (Visits, Bed days) Cost per UnitNk Bed Occ. % Output (Visits, Bed days) Cost per UnitNk Bed Occ. % Output (Visits, Bed days) Cost per UnitNk Bed Occ. %
Outpatient services 20,713 52 41,475 37 26,525 63
Inpatient services 57,562 79 79% 55,887 72 84% 9,768 122 45%

Unit costs are higher at the small community hospital compared to the larger regional and national referral hospitals. This was partly explained by the fuller use of fixed assets and labor in the larger hospitals due to their higher volumes of patients. There appeared to be inefficiency also in the community hospital in the use of drugs, and the Ministry is working to improve control over the use of drugs and medical supplies in hospitals. The costing also gave the Ministry a better idea about the level of cost recovery through user fees. Cost recovery ranged from 14% to 20%, which was higher than had been thought given the nominal fees charged for most services and the generous fee exemption program.

Implementation
Both versions of the tool require that the user receive some initial training to gain an understanding of the general principles of hospital costs and the costing process and how to interpret the results for management use. It is important to understand the management accounting approach that is adopted for dealing with hospital overheads (indirect costs). For the Excel version, it is important that the user is comfortable with the Excel program and is able to enter data in the designated cells and add or delete rows and columns. The automated version of the tool requires training on how to enter data and generate reports from the tool. The data that is input into both versions of the tool may not always be readily available and may require special data collection effort. This may apply for example to data on the use of drugs and non-pharmaceutical supplies that may not be routinely available for each department or cost center in the hospital.

Disclaimer
The software, data and information contained in MASH are being provided "as is." Abt Associates Inc. makes no representation or warranty, either express or implied, as to their accuracy, completeness or fitness for a particular purpose. Abt Associates Inc. will not be liable to any extent relative to the use or reliance of the software, data, or information. Further, the mention of specific companies or of certain products that may be required for the operation of this software does not imply any endorsement, recommendation, or license to use such items. Abt Associates Inc. is not responsible for any technical assistance or support associated with this software.


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