Forvaltning av medisinsk-teknisk utstyr (MTU) : En analyse av forvaltningskostnadene knyttet til MTU (kapitalkostnadene og kostnadene knyttet til å yte medisinsk-tekniske tjenester

Abstract

Sammendrag forskningsspørsmål og konklusjoner 1. Er finansieringen av kapitalkostnadene fra eier gjennom de regionale helseforetakene til helseforetakene tilstrekkelig og adekvat til å gjøre helseforetakene i stand til å gjenanskaffe den medisinsk-tekniske utstyrsparken? Dette spørsmål er besvart i kapittel 3.6, side 49: De bedriftsøkonomiske avskrivningsmekanismene gir en inntektsstrøm til de regionale helseforetakene, som står frie til å fordele andelen tilbake til datterforetakene. I utgangspunktet var det en underdekning i eiers finansiering av avskrivningene, som i 2004 ble noe rettet opp ved opprettelsen av et strukturfond for meravskrivning og per 31.12.2007 ble rettet endelig opp ved økte tilskudd slik at all avskrivning i prinsippet dekkes. I årene 2002 – 2007 har det i de regionale helseforetakene vært en skjevfordeling av denne inntektsstrømmen til avskrivning gjennom en økning i kapitalbeholdningen knyttet til bygninger og andre anleggsmidler, mens det for MTU har vært en nedgang. Verdien av realkapitalen i MTU reduseres. Underfinansieringen av kapitalkostnadene knyttet til MTU gjør at helseforetakene (sykehusene) på sikt ikke vil være i stand til å gjenanskaffe MTU anleggsmidlene etter at de er avskrevet, uten ekstraordinære investeringstilskudd.

2. Hva er de årlige forvaltningskostnadene for medisinsk-teknisk utstyr i perioden år 2002 til år 2008? Dette spørsmål er besvart i kapittel 6.5, side 68: Forvaltningsindeksen, som et uttrykk for forvaltningskostnadene for den undersøkte MTU populasjonen – har i to målinger økt til sammen med 0,4 % - poeng siden 1.1.2002, til 4,4 % i 2008-datasettet (svarende til at totale forvaltningskostnader for den beskrevne utstyrspopulasjonen har økt fra om lag 104 mill kr til om lag 160 mill kr). Det er en entydig samvariasjon mellom forvaltningsindeksen og en økning i utstyrspopulasjonens alder. Basert på de kvalitative kontroller utført på datasettene, anses endringen av forvaltningskostnadene som signifikant.

Summary in English The subject of this thesis is «Management of medical devices. An analysis of capital depreciation costs and management costs of medical devices». The aim of the thesis is to find the answers to two research questions: to which extent does the national governmental owner’s financing of the capital depreciation costs and the regional health enterprises’ division of this cash flow between real estate and medical equipment allow investment/reinvestment in medical devices, and what are the management costs of medical devices and clinical engineering services measured in the period 2002 – 2008?

As clinical medicine has become increasingly dependent on more sophisticated technologies and the complex equipment associated with it, the discipline of clinical engineering (CE) has evolved within hospitals in CE Departments. The equipment used in the diagnosis and treatment of patients in a hospital is denominated as «medical devices» (MD), in Norwegian «medisinsk-teknisk utstyr» (MTU). A short introduction to the evolution of medical technology is presented, e.g. the discovery of the x-rays in 1895 – which was the start of technological medicine. The trade and safety of MD is regulated in the European Union with the MD Directive and national amendments since 1998, and an introduction to the regulatory systems is presented. On January 1, 2002, the ownership of and responsibility for all public Norwegian hospitals were transferred to the Government. The hospitals were organised in five regional health enterprises (now four), with all hospitals as enterprises and separate legal subjects administrated as business enterprises according to the laws of accounting. An effect is accounting of the capital costs associated with the fixed assets in the enterprises, the annual capital depreciation in the balance sheet and the corresponding expenditure in the profit and loss accounts. The data sets studied are the MD population of Rikshospitalet university hospital and the regional health enterprise Helse Sør. Nearly 40.000 recorded MD units with an accumulated procurement cost of approximately 3.4 bill NOK is included, as well as data on service provisions from the 7 CEDs in the same region. The method for studying the management cost of medical devices and clinical engineering services, is to measure («benchmark») all service and engineering costs expressed as a percentage of the accumulated equipment cost (accumulated historic cost).

The results and answer to the first research question is that the governmental owner has over time modified the financing of the capital depreciation mechanisms to cover nearly all of the depreciation through a block grant to the regional enterprises. However, the cash flow from the regional enterprise to the local enterprise (hospital) for medical equipment is not enough to cover all local depreciation costs and thus does not allow the enterprise to reinvest in medical devices. It will not be possible to reinvest or repurchase equipment which is out of economic life (end of depreciation) unless extraordinary grants are given.

The answer to the second research question is that the management cost of medical devices and clinical engineering services, expressed as a percentage of the accumulated equipment cost, has increased in two steps of 0,2 % to 0,4 % in the period 2002 – 2008, to a mean index of 4,4 %. In the same period the mean age of the equipment populations have increased. The measuring method and the results correlate well with international data referred. The increase in cost index is considered to be a qualitatively valid and significant co-variation to the mean age if the equipment population. The mean index correlates well with internationally published data.