[Outsourced service management of the catheterization laboratory in the cardiology department: lights and shadows].
BACKGROUND
The aim of this study was to compare the economic impact and results achieved by recourse to outsourced management of the procedures carried out in the electrophysiology and catheterization laboratory of the Department of Cardiology of the Crema Hospital with the in-house setting up and operation of the same activities.


METHODS
The comparison between the two possible options, "make" or "buy in", was made using the methodology of advanced direct costing, which provides for the allocation of only direct fixed and variable costs to clinical procedures, the subject of calculation. In addition to the financial evaluation, the quality variables showing the advantages and limitations of outsourcing in terms of organizational improvements, streamlining of the organizational structure, operational efficiency and improvement of the quality of service, were examined.


RESULTS
The financial evaluation from 2002 to 2006 came out in favor of "make" as opposed to "buy in". Income derived from diagnosis-related-group payments for the more than 4000 procedures carried out was Euro26.239.034,96. On the basis of the economical evaluation the second contribution margin was slightly inferior with the "buy in" than with the "make" hypothesis. Specifically, it is Euro16.397.669,96 in the "buy in" and Euro16.753.579,16 in the "make" hypothesis, with a difference of Euro355.909,20 (-2%).


CONCLUSIONS
The economic advantage lies with the "make" alternative compared with "buy in", nevertheless, outsourcing offers greater operational efficiency, better cost control, setting up of the laboratory within a very short time, simplified administration (single point of contact) and an opportunity to concentrate on core business. However, there are limitations due to greater dependence on the supplier, not all the equipment provided for under the contract was used, and loss of management know-how in non-core business areas.
Inama
Giuseppe
G
U. O. di Cardiologia, A.O. Ospedale Maggiore di Crema, Crema. g.inama@hcrema.it
Claus
Marco
M
Nossai
Wanda S Pinna
WS
Pedrinazzi
Claudio
C
Durin
Ornella
O
Catanoso
Antonio
A
Cacucci
Michele
M
Valentini
Paolo
P
Rizzini
Angelo Lodi
AL
Agricola
Pietro
P
Romagnoli
Giulio
G
Magarini
Anna Maria
AM
Bruni
Ezio
E
Aguzzi
Regolo
R
Soccini
Fulvio
F
Maltagliati
Diego
D
D002309:Cardiology; D016507:Cardiology Service, Hospital / Q000191:economics / Q000458:organization & administration; D002404:Catheterization; D003363:Cost Control; D003953:Diagnosis-Related Groups / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007558:Italy; D007755:Laboratories, Hospital / Q000191:economics / Q000458:organization & administration / Q000592:standards; D020416:Outsourced Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care