Harvard Case - Partners In Health: Costing Primary Care in Haiti
"Partners In Health: Costing Primary Care in Haiti" Harvard business case study is written by Robert S. Kaplan, Mahek A. Shah. It deals with the challenges in the field of Accounting. The case study is 17 page(s) long and it was first published on : Jan 4, 2018
At Fern Fort University, we recommend Partners In Health (PIH) adopt a comprehensive cost accounting system that utilizes activity-based costing (ABC) to accurately capture the costs of providing primary care in Haiti. This system will enable PIH to make informed decisions regarding resource allocation, pricing strategy, and program effectiveness, ultimately leading to improved healthcare outcomes for the Haitian population.
2. Background
Partners In Health is a non-profit organization dedicated to providing high-quality healthcare to underserved communities around the world. The case study focuses on PIH's operations in Haiti, where they face challenges in providing affordable and accessible primary care due to limited resources and a complex healthcare system. The case highlights the need for a robust cost accounting system to inform decision-making and ensure financial sustainability.
The main protagonists in the case are:
- Dr. Paul Farmer: Co-founder and Chief Strategist of PIH, advocating for equitable healthcare access.
- Dr. Ophelia Dahl: Co-founder and CEO of PIH, responsible for operational efficiency and resource allocation.
- PIH's Finance team: Tasked with developing a cost accounting system to accurately reflect the costs of providing care.
3. Analysis of the Case Study
The case study presents a complex scenario where PIH needs to balance its commitment to providing high-quality care with the need for financial sustainability. To analyze the situation, we can utilize a framework that considers both financial and operational aspects:
Financial Framework:
- Financial Statements: PIH's financial statements, including the balance sheet, income statement, and cash flow statement, provide insights into the organization's financial health.
- Cost Accounting: PIH's current cost accounting system is inadequate for accurately capturing the costs of providing care, especially in a complex environment like Haiti.
- Financial Analysis: Analyzing PIH's financial performance through ratios and trend analysis can reveal areas for improvement and identify potential financial risks.
- Budgeting: A robust budgeting process is crucial for PIH to plan and manage its resources effectively.
Operational Framework:
- Activity-Based Costing (ABC): Implementing ABC would allow PIH to allocate costs more accurately to specific activities, providing a clearer picture of the true cost of providing care.
- Organizational Structure and Design: PIH's organizational structure should facilitate efficient operations and effective cost management.
- Performance Indicators: Establishing clear performance indicators will help PIH track progress towards its goals and identify areas needing improvement.
- Change Management: Implementing a new cost accounting system requires careful change management to ensure buy-in from all stakeholders.
4. Recommendations
1. Implement Activity-Based Costing (ABC): PIH should adopt an ABC system to accurately capture the costs of providing primary care in Haiti. This will involve identifying and analyzing all activities involved in delivering healthcare services, allocating costs to these activities, and then assigning costs to specific patients or services.
2. Develop a Comprehensive Cost Accounting System: This system should include:* Accounting Procedures and Policies: Clear and consistent accounting procedures and policies are essential for accurate cost tracking and financial reporting.* Cost Allocation: A transparent and equitable cost allocation methodology should be established to ensure fairness and accountability.* Cost Analysis: Regular cost analysis will help PIH identify areas where costs can be reduced or efficiency improved.
3. Enhance Budgeting and Financial Planning: PIH should develop a robust budgeting process that aligns with its strategic goals and incorporates the insights gained from the ABC system. This will involve:* Budgets and Budgeting: Developing detailed budgets for each department and activity, with clear targets and performance metrics.* Cash Flow: Monitoring cash flow closely to ensure financial stability and meet short-term obligations.* Variance Analysis: Regularly analyzing variances between actual and budgeted costs to identify areas for improvement.
4. Improve Financial Performance Measurement: PIH should establish key performance indicators (KPIs) to track its financial performance, including:* Profitability: Measuring the profitability of different services and programs to inform pricing strategy and resource allocation.* Financial Performance Measurement: Tracking key financial metrics such as return on investment (ROI) and cost per patient.
5. Enhance Corporate Governance: PIH should strengthen its corporate governance framework to ensure transparency, accountability, and financial sustainability. This includes:* Boards: Establishing a strong board of directors with expertise in finance, healthcare, and non-profit management.* Corporate Governance: Implementing robust internal controls and ethical guidelines to prevent fraud and misconduct.
5. Basis of Recommendations
These recommendations are based on the following considerations:
- Core Competencies and Consistency with Mission: Implementing an ABC system aligns with PIH's mission of providing high-quality healthcare to underserved communities by ensuring efficient resource allocation and financial sustainability.
- External Customers and Internal Clients: The ABC system will benefit both patients by ensuring access to affordable care and PIH staff by providing a clearer understanding of their roles and responsibilities.
- Competitors: While PIH is a non-profit organization, understanding the cost structures of other healthcare providers, both in Haiti and globally, can inform its pricing strategy and resource allocation decisions.
- Attractiveness ' Quantitative Measures: Implementing an ABC system can improve PIH's financial performance by reducing costs, increasing efficiency, and improving resource allocation. This can be measured through KPIs such as ROI, cost per patient, and program effectiveness.
6. Conclusion
By adopting a comprehensive cost accounting system that utilizes activity-based costing, Partners In Health can achieve greater financial transparency and efficiency, enabling them to continue providing high-quality healthcare to underserved communities in Haiti while ensuring the organization's long-term sustainability.
7. Discussion
Other alternatives to ABC include traditional cost accounting methods, but these are less accurate and less effective in capturing the true costs of providing care in a complex environment like Haiti. The implementation of ABC does present risks, such as the need for significant investment in data collection and analysis, potential resistance from staff, and the challenge of accurately allocating indirect costs. However, these risks are outweighed by the potential benefits of improved decision-making, resource allocation, and financial sustainability.
8. Next Steps
- Phase 1 (Months 1-3): Develop a detailed plan for implementing ABC, including data collection requirements, cost allocation methodology, and training for staff.
- Phase 2 (Months 4-6): Pilot the ABC system in a specific department or program to test its effectiveness and identify areas for improvement.
- Phase 3 (Months 7-12): Roll out the ABC system across the organization, providing ongoing support and training to staff.
- Phase 4 (Ongoing): Continuously monitor and evaluate the ABC system, making adjustments as needed to ensure its effectiveness and alignment with PIH's strategic goals.
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Case Description
Partners in Health, a global NGO focused on delivering health care to residents of rural underserved communities, conducts a project on the cost of primary care at five sites in the Central Highlands of Haiti. It devises a simple approach for tracking the resources used by patients being treated for diverse medical conditions, as an input to a time-driven activity-based costing model. The results show considerable cost diversity across the five sites, but organizational leaders differ on the interpretation and action implications of the findings.
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