“To value the cost of an average bed day, according to the diagnosis for surgical medical hospitalization and medium care units of a high complexity establishment in Chile”, was the objective of study of the article ISI prepared by the professor of the Department of Management Control and Information Systems Liliana Neriz.
The research, called “Costs Based on Surgical Medical Unit Activities”, was published in the Chilean Medical journal. The study focused on medium-care and surgical units, a topic that had not yet been addressed in Chile.
“Hospitals must have management tools to enable them to meet – with greater autonomy from health services – all their requirements with the resources allocated,” she said.
The article highlights that the bed management and use of health institutions, together with their resources involved, account for 58% of expenditure on tertiary establishments. It is therefore of “paramount importance that institutions manage these resources in a good way, clearly bearing out the costs involved in procedures and services”.
Professor Neriz notes that the study based on the activity-based costing methodology allows “to identify those processes or services that are more expensive within hospitalization units and provides detailed information, as to why some units consume more resources than others”, by providing disaggregated information on the causes of cost differences between medical specialties. It also provides a behavior model of hospitalization units with high level of accuracy, depending on the diagnosis. Its application would improve the management of the unit and similar ones, he said.
The study concludes that respiratory, renal and circulatory – cardiovascular specialties represented the most expensive bed days in surgical medical units, at an annual indirect cost, according to this methodology, of $427,827,901; $119,165,539 and $450,144,556, respectively; and in the intermediate units at an annual cost of $764,922,522; $124,026,392 and $1380,289,077. Meanwhile, the procedure with the highest annual indirect cost for its realization was the high patient. This is explained by the high consumption of human resources used by this procedure.
Measurement
The study shows that “to value benefit costs in more detail, it is necessary to validate whether the hospital’s costing system allows it, as most of these are based on volumetric allocations that do not provide adequate information to more accurately determine the cost of services.
It adds that “an alternative to these systems is Activity-Based Costing (ABC), which considers that an organization’s resources are consumed by different activities and in turn combinations of them must be executed to deliver a product and/or service. By costing activities, it is feasible to value the cost object (product or service) more accurately and obtain information to assess the efficiency of the different processes, providing a more accurate basis for decision-making at the managerial level.”
In the measurement, this methodology was used plus direct observation of the procedures performed and the expert criterion, to build the cycle activities associated with the procedures. In this way, the consumption of the resources involved was estimated. For the analysis, 6,096 hospital egresses were considered for the 111 most recurrent diagnoses (occurring at least 12 times a year) in 2017.
The stages of this methodology consisted of “lifting procedures, identifying resources used, analyzing egress diagnostics, defining cost objects, resource cost inducers, cost of procedures, procedure inducers and value of the cost object, which corresponds to the day bed by specialty”.
This study excluded expenditure from clinical support units and administrative activities; as well as the costs of clinical procedures associated with hospitalization, according to each specialty, of which the direct costs of specific clinical treatments are not considered.
