Study On Applying Time-Driven Activity-Based Costing To Calculate Single Disease Cost

BackgroundWith the continuous deepening of public hospital reform and the reform of medical insurance payment methods,it had become an important task for hospital managers to control the excessive growth of medical expenses and hospital costs.As the basic work of cost management,cost accounting is an important aspect for hospitals to adapt to the new round of medical reform and achieve their own sustainable development.Disease cost accounting is a further refinement of hospital cost accounting,which can provide hospital administrators with more comprehensive and effective cost information.At present,Chinese hospitals are exploring the methods to calculate disease costs,but there are not yet formed a standard cost accounting system.ObjectiveThis paper aims to study the cost accounting method of single disease and provide ideas for the construction of hospital disease cost accounting system in China.By trying to use time-driven activity-based costing(TDABC)to calculate the cost of a single disease,providing cost information to the hospital and studying the composition and influencing factors of the cost of a single disease.Based on the analysis,it can help hospital administrators to rationally allocate medical resources and reduce waste to meet the requirements of current public hospital reforms and cost refinement management,improving hospital competitiveness.MethodsTaking simple ankle fracture of one hospital as an example,TDABC was used to calculate the cost of the single disease.The method of Statistical description was used to analyze cost data and cost composition.Paired Sample T Test was used to compare the difference between single disease cost and hospitalization expenses.Pearson correlation analysis explores the relationship between single disease cost and hospitalization expenses,material cost and disease cost.What s more,this study uses Independent Sample T Test,single factor variance analysis,nonparametric test to explore the influencing factors of the disease cost.Results(1)The treatment workflows with simple ankle fractures inpatients can be divided into 6 process maps,including admission.laboratory examination,imaging examination,preoperative preparation,surgery,and postoperative rehabilitation.The capacity cost rate(CCR)of different human resources varies,the highest is 3.1 yuan per minute for orthopedic surgeons and the lowest is 2.1 yuan per minute for orthopedic nurses.The highest capacity cost rate of the equipment is CT machine(320 layers),which is 2.3 yuan per minute,and the lowest is the electrocardiograph,which is 0.004 yuan per minute.(2)The average cost of simple ankle fractures is 3,9790.2 yuan,and most people's treatment cost is between 30,000 and 40,000 yuan,accounting for 30%of total cases.In the cost structure of simple ankle fracture,material cost is the highest proportion and accounting for about 64%of total cost,followed by drug cost and labor cost.Material costs are highly positively correlated with disease cost.In terms of labor costs,the average cost of orthopedic surgeons is the highest,which is 1771 yuan.The average cost of orthopedic nurses is the lowest,which is 216.6 yuan.In terms of the activity cost,some short-term and cheap activity costs range from tens of yuan to several hundred yuan.In time-consuming and complex activities,the average cost of surgery is the highest,which is 2212 yuan.(3)The average hospitalization expenses for simple ankle fracture cases was 40517.4 yuan,which was 727.2 yuan higher than the average cost of the disease.The difference was statistically significant.There are 57 cases' hospitalization expenses was higher than cost,and the hospitalization expenses of 32 cases was lower than cost.The cost of single disease is highly positively correlated with hospitalization costs.The average disease cost of excluding material is 14523.2 yuan,which is 3476.8 yuan lower than the maximum charge of 18,000 yuan specified in the Notice of Relevant Issues Concerning Hospital Charges by Provincial Medical Institutions.However,there are still 18 cases' cost exceeding 1 8,000 yuan,accounting for 20%of the total number of cases.The average cost of the exceeding-expenditure group was 2,1 107.7 yuan,which was 3107.7 yuan higher than the highest charge,and the over-expenditure rate was 17%.(4)The cost of microscopic orthopedics is about 33,000 yuan,which is the lowest of the four departments.The cost of minimally invasive orthopedics is about 48,000 yuan,which is 15,000 yuan higher than that of microscopic orthopedics.The cost of hospitalization days within a week is the lowest,about 25,000 yuan,and the cost of hospitalization over three weeks is the highest,about 47,000 yuan.The time of activity will affect the cost of the activity.As time increases,the cost of activity will also increase.For every minute increased,the cost of laboratory-examination activity increased by about 2.5 yuan,and the cost of imaging-examination activity increased by about 2.7 yuan.For every minute of operation time increased,the cost of surgery activity increased by about 17 yuan.The average hospitalization days,postoperative average hospitalization days,and drug costs of the exceeding-expenditure group were higher than those of the non-exceeding-expenditure group,and the difference was statistically significant.Only 18%of patients with simple ankle fractures had a treatment process that was consistent with the clinical pathway.The treatment of all cases in the exceeding-expenditure group did not meet the clinical pathway.Conclusions and SuggestionsIt is feasible to use the time-driven activity-based costing method for single disease cost accounting,and accurate results can be obtained.The main components of the cost of fracture are material,drug and labor costs,which have the highest proportion of material costs and are highly positively correlated with disease cost.The cost of single disease is highly positively correlated with hospitalization expenses.Length of stay is an important influencing factor for the cost of the single disease.As the working time is extended,the cost of the corresponding activity will increase.There is a widespread problem of long average length of stay,a high drug cost,and a failure to follow the clinical pathway in cases whose cost of treatment exceeds the maximum fee stipulated in the Notice of Relevant Issues Concerning Disease Charges by Provincial Medical Institutions.Based on the research results,the following suggestions are made:(1)Strengthen the accumulation of hospital data,improve the construction of information systems,and form a database that can support cost accounting.(2)Pay attention to the number of preoperative examination items and avoid repeating worthless examinations.(3)Shorten the time of the activity and improve the treatment efficiency.(4)Regulate the use of high-value consumables reasonably and control material costs.