The resource utilization rate (RUR) is the main determinant of operating results.

The matrix approach calculates actual direct and indirect revenues and expenses per patient to reconstruct the economic performance of care units. It is useful in a context of operating losses with constrained budgets.

The initial conclusions are known but not documented. When the TUR is low, the margins per patient are all low. When the TUR is high, the margins per patient are better. The TUR appears to be the key factor in the financial balance of an EPS or ESPIC. The staff TUR is equal to “time dedicated to the patient/time dedicated to care.” The disparities in this ratio between EPS and ESPIC are significant.

Indirect costs are allocated according to the activity of the entire department and not according to the type of activity or the rate. Consumables and all variable costs play a minor role except for certain activities (robotics, interventional cardiology, and chemotherapy in particular). It seems difficult to avoid indirect costs in healthcare services. GHSs are designed for optimal activity and full-capacity operating conditions. Even though T2A often represents only 50% of revenue, TUR is key. Ultimately, the performance of EPSs impacts their ability to finance their investments and operations.

The strong performance of certain activities does not always compensate for losses in poorly performing activities. All resources across all departments must be utilized: cash cows are no longer sufficient. The choice of activities and the appropriate level of investment are critical.

Good organization promotes quality of care and maximizes the use of resources by the institution. This is the real factor in an institution's success. In a context of unmet demand, it increases the volume of activity and limits waiting times to increase productivity and improve economic results.

Differences in the degree of exposure to the risk of under-activity and the risk of under-utilization of resources contribute to differences in performance between types of institutions. EPSs and most ESPICs multiply fixed costs exposed to the risk of under-utilization. They pay doctors and ancillary activities, particularly exploratory activities, with a high risk of under-activity and/or under-utilization. For-profit private clinics are less exposed to the risks of underutilization. They do not directly remunerate the vast majority of their doctors and focus on one type of activity. The degree of exposure to the risk of underutilization plays a major role in health services.

The economic performance of EPS and ESPIC depends primarily on their productivity and organization. The coexistence of waiting lists and operating deficits is a warning sign that productivity needs to be addressed. Austerity plans will have only a marginal or even counterproductive impact on results without reorganizing work and patient flows.

Is this a call for Stakhanovism? The enormous productivity gains made possible by AI, lean management, and new treatments allow for improved use of resources, unlike austerity, across-the-board cuts, or denial of care. We are at a turning point in the performance of healthcare services. This is welcome news, as financing healthcare through borrowing is no longer sustainable.

Notes :

[1] The matrix approach establishes continuity between cost accounting and micro-costing to complement each of these methods. Alain SOMMER, Vincent TRÉMION, Olivier LEFEBVRE, Grégory VIDOR - Finances Hospitalières No. 194, October 2024.