Macro-and Micro-Costing of Accident and Emergency Services for Developing Standard Costing Guideline

Abstract

Background : Cost of service is important information to know the financial burden of the hospital and to manage health systems efficiency.

Objective : To study the macro and micro costing of accident and emergency department (A&E) in order to develop standard costing guideline.

Method : This was a research and development of cost analysis methodology on provider perspective. The standard top-down and micro-costing approaches were drilled down to cost of service item using electronic databases from hospital information technology systems. Eleven hospitals voluntarily participated this R&D (4 regional, 1 general and 6 community hospitals).

Results : The overall patient service costs of biggest hospitals were 2.2 billion baht with 129 million baht of patient service cost at A&E compared with only 39.9 million baht of direct labor, material and capital costs at A&E, and the rest (89.1 million baht) were the costs of other services to patients treated at A&E. The overall patient service costs of the smallest community hospitals were 61.8 million baht with 12.7 million baht of patient service cost at A&E compared with only 7.4 million baht the direct costs at A&E, and the rest (5.3 million baht) were the costs of other treatments to patients treated at A&E. The detailed allocations of costs to level of billing group (laboratory investigation) down to billing subgroup (clinical chemistry) and service item (dextrostix) were proven plausible with the existing hospital IT systems. The research allowed comparisons of service item costs among different sizes of hospitals.

Conclusion : Attention should be paid on development of detailed costing methodology with hospital information systems particularly the emergency services to synthesize the appropriate payment model for accident and emergency services in Thailand.