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Simon2 , F. Calarge3, S. This matter has also involved companies and their activities in the social, environmental and financial scope. However, while companies have started showing greater interest in preserving the environment and in considering social aspects, the measurement of involved costs has not been an easy task. The concept of Complete Ecological Cost Accounting CECA is a tool that intends to measure the costs in a comprehensive manner, integrating traditional accounting and so-called social-environment accounting. This article aims to make a critical analysis of the CECA model and proposes guidelines for its improvement. The focus is to suggest a complementation of the model by integrating parameters to collect data and assess results from a qualitative and quantitative point of view, thereby allowing companies to evaluate their level of maturity as it relates to socio- environmental issues.
The present study had the objective of estimating the economic costs of tuberculosis for the healthcare system and for the families of patients undergoing treatment for tuberculosis. It also aimed to contribute towards the development of similar studies in other contexts, through laying out in detail the methodology utilized.
METHODS To study the cost of tuberculosis for patients and their families, the sample size was defined by convenience, to include patients who had received a diagnosis of tuberculosis for the first time, 33 hospitalized patients and 39 patients with multiresistant tuberculosis.
The new cases were recruited from among the recently diagnosed cases of tuberculosis at ten healthcare centers in Salvador, State of Bahia.
The hospitalized patients were recruited from among the patients in the reference hospital for tuberculosis treatment in the city, and the multiresistant patients were recruited from the outpatient service of this same hospital. The information was collected using a standardized questionnaire that was administered by nurses, nursing auxiliaries or technicians and social workers who had been trained for this purpose.
For the new patients beginning outpatient treatment, the objective of the questionnaire was to obtain information on the costs that they had had prior to and subsequent to the start of tuberculosis treatment. The new patients were recruited during the months of February and March For the hospitalized patients, the objective was to verify the costs during the six months preceding the date of hospitalization and the costs during their hospitalization.
The hospitalized and multiresistant patients were recruited during the months of July and August For the multiresistant patients, the objective was to estimate the costs over a one-year period prior to the date of the interview. For the new outpatients, the questionnaires were applied on three occasions: at the start of their treatment to register their costs prior to the diagnosis and three and six months later.
This last application coincided with the end of the treatment. For the multiresistant and the hospitalized patients, the questionnaire was applied on a single occasion the information collected from the patients is shown in Table 1 published on ISC's website. For this collection, six healthcare centers from among the twelve centers where tuberculosis control activities were being performed in the municipality of Salvador were selected. This selection was based on the availability of the information needed for calculating the costs.
Thus, the centers that had all the information needed for the cost calculations were selected. The files of the new outpatients and multiresistant patients were also reviewed in order to determine the average number of consultations and tests that these patients did. The files of the hospitalized patients were not reviewed. The costs of the epidemiological surveillance of tuberculosis were not estimated. For analysis, the procedures of cost accounting were utilized, in which the proportion of the resources that is utilized for each activity is considered in order to determine the unit cost of this activity.
The average cost to the family varied according to the type of treatment needed. The average cost to a family for a hospitalized patient was calculated only for the number of days of hospitalization. Cost to public services The outlays on attending to and controlling tuberculosis within the public sector, for each health facility, are presented in Table 2.
This shows the cost estimates for new cases according to the healthcare center. The two most relevant cost items for healthcare units were the costs of the professionals exclusively within the program and the cost of medications.
The variations in the cost of the treatment that were observed in the six centers studied result from the fact that some centers have professionals who are not available in others for example, nutritionists , and from the variation in the productivity of the centers. Some centers function as referral centers for large areas, thus attracting greater numbers of patients.
Consequently, these centers present lower average costs than other centers at which smaller numbers of patients are treated.
This same calculation procedure was utilized for estimating the costs of chemoprophylactic treatment and retreatment. The average cost of hospitalization was estimated only for the public reference hospital for hospitalization of patients with tuberculosis.
The patients with a diagnosis of multiresistant tuberculosis were also treated at this hospital. Cost to the private sector The cost of tuberculosis to the private sector is shown in Table 4. A matriz BCG Matriz BCG modificada por fluxo de caixa Receita das empresas pesquisadas em Fatores do macro ambiente Segundo Wind p.
Segundo Dalsasso , p. Segundo Fahey e Randall , p. Segundo Wind , p. Network Wizards — Jan. Segundo KPMG , p. CFC, , p. Segundo Zanluca , p. Segundo o Conselho Federal de Contabilidade, em Fev.
RAZA, , p. Segundo Laurentino , p. Duarte , p.
Em pesquisa realizada por Duarte , p. Adaptado de Atkinson ; p. Segundo Marion , p. Figura 1: Adaptado de Marion , p. Em outras palavras: Como Marion , p. De acordo com Martins , p. No entanto, o mesmo autor afirma em sua mesma obra p. Adaptado de Martins ; p. Teixeira , p. De acordo com Johnson e Kaplan , p. De acordo com Oliveira , p. Segundo Oliveira , p. Ainda segundo Oliveira , p. Componentes do ambiente Fonte: Figura 8: Porter , p.
Oliveira , p. No contexto do ambiente interno da empresa, devem-se levar em conta os pontos fortes e fracos, ou seja, aquilo que a empresa faz bem e aquilo que precisa ser melhorado.
Figura 9: Mintzberg, apud Ansoff , p. A matriz BCG Fonte: Adaptado de Boston Consulting Group http: Tabela 3: Adaptado de Oliveira , p. No entanto, segundo Oliveira , p. Logo, o executivo deve levar em conta os seguintes fatores: The focus is to suggest a complementation of the model by integrating parameters to collect data and assess results from a qualitative and quantitative point of view, thereby allowing companies to evaluate their level of maturity as it relates to socio- environmental issues.
Keywords: externalities, critical analysis, literature review. For and big companies: the necessity to adapt ROMANINI , the discussion of their organizational and operational areas sustainable companies does not concern to the concepts and demands of only big companies, which suffer more sustainability.
This is due mainly to the pressure from stockholders to show that fact that sustainability is becoming a new they do not adopt wrong socio- competitive approach CALARGE et al. Society has also This article also continuous improvement principle.
In particular, the article three dimensions on which companies suggests complementing the CECA model must focus: the social, the ecological and with parameters to collect data and assess the economic. Through this Brazilian Journal of Biosystems Engineering v.
It covers a wide range shows these steps.
The In order to reach the goal proposed in focuses are understood their bases, this research, studies based on a explained in order to create a framework bibliographical survey of secondary for analysis and a discussion of the main sources were made, the main pillars in the corporate and academic characteristics of which are shown on environments.
The critical analysis aims to Table 1. Table 1. Classification of the type of bibliographical survey performed in the research Literature Characteristics review Justification classification Performed on a specific topic, so that the summation of Purpose Analytical these studies provides an overview of the subject studied.
Range Thematic The work is resented inside a specific clipping of a theme. This includes recent published literature and the current Function Update state of knowledge, thus drawing attention to work carried out on the most important issues.
The selection of papers was done in a selective manner, Approach Critical emitting judgments about them. Some tools may be used consumption of natural resources as part of in this phase, such as: evaluation of the total production costs of its goods and risks, tracking the energy and material services.
Currently, companies The first discussion pointed out in data such as cost analysis, the focus of the the analysis refers to the adequacy of the model. In addition, the fact Regarding the new alternatives that the negative externalities are related to proposed for performing corporate sensitive issues such as, for example, accountancy, the CECA tackles two allocation of fines for non-compliance with fundamental points: the translation of environmental laws and accidents at work.