Activity-Based Costing of Hemodialysis for End-Stage Renal Disease Hospitalized Patients under the Universal Health Care Coverage Policy in Fiscal Year 2017: A Case Study of Rajavithi Hospital

Abstract

Background : End-Stage Renal Disease is a global health concern as well as Thailand’s public health also increasing cost of service and treatment. From financial analysis of hemodialysis activities is therefore important to manage and improve the financial cost, service and treatment system for new standard in the future.

Objective : The research aimed at analyzing costs of hemodialysis using activity-based costing approach among end-stage renaldisease patients hospitalized at the Rajavithi Hospital in the fiscal year 2017.

Method : Based on provider’s perspective, the proportions of resources are consumed in each recurring activity and investment costs. Medical records were retrieved from hospital database retrospectively during May and December, 2018. We also conducted prospective data collection on standard time of each activity. Research participants were 133 patients at the hemodialysis unit with 713 sessions of hemodialysis. There were 34 operational officers who worked at the hemodialysis unit involved with those participants. The secondary data on costs data (labor, material, and investment costs) and activity log were analyzed for frequency distribution, mean, percentage and standard deviation using calculated function in Microsoft excel version 2010.

Results : Results revealed that the total costs of hemodialysis in the fiscal year 2017 were 1,547,170.83 baht (mean = 2,169.95 baht). Nevertheless, the hospital could reimburse only 1,109,300 baht in the fiscal year 2017 which equal to 1,555.82 baht per session in average. It was found that the hemodialysis patient care unit incurred the highest portion of the total costs at 367,986.85 baht or 516.11 baht per session, whereas hemodialysis patient coordination unit incurred the lowest portion of the total costs at 89,084.92 baht or 124.94 Baht per session. The material costs were the highest portion at 803,474.83 baht (51.93%) followed by labor cost of 677,929.40 baht (43.81%). Whereas the investment cost were 65,766.59 baht which was lowest portion. The proportion of the material costs to the labor costs to the investment costs were 51.93 to 43.81 to 4.25.

Conclusions : The results could be used for recommendation to the decision makers in order to allocate the budget for the hemodialysis service. Furthermore, the research findings also could be used as a guideline for the budgeting management in order to reduce neither unnecessary nor inefficient costs.