Activity-based Unit Cost Analysis of Dementia Diagnostic Services at Outpatient Unit in Chiang Mai Neurological Hospital

Abstract

This is a descriptive study, whose objectives were: (1) to determine the cost of dementia diagnostic services per patient;  (2) to determine the cost per dementia diagnostic activity;  and (3) to compare the cost of dementia diagnostic services with the revenue collected according to the health insurance eligibility of the patients who had been diagnosed with dementia in the outpatient unit at Chiang Mai Neurological Hospital. The study involved a random sample of 45 patients’ data, randomly selected out of 170 annually diagnosed dementia patients, from 1 October through 31 December 2018. Data were collected using the dementia diagnostic service activity dictionary and the investment and operational cost recording forms for primary data on time spent and numbers of activities, and secondary data on investment costs from the hospital’s finance, supplies, policy and administrative sections. The data were then analyzed to determine means and percentages. Results showed that: (1) The overall average cost of dementia diagnostic services per patient was 4,646.68 baht; and the ratio of labor cost to material cost to capital cost was 95.41:4.23:0.36; (2) The cost per activity was 641.96 baht for history-taking and patient preparation before screening, 1,139.70 baht for dementia screening, 2,004.08 baht for diagnosis by a neurologist, and 594.28 baht for self-care and appointment adherence advice. The ratio of the preliminary screening cost to diagnostic stage cost to post-diagnosis cost was 3:3.7:1;  and (3) The average cost of dementia diagnostic services was 4,040.01 baht for one patient under any type of government health insurance schemes. However, under the Universal Coverage Scheme, the hospital could get reimbursed for the actual cost but not exceeding 650 baht, while the full actual cost could be reimbursed for those under the Social Security Scheme and the Civil Servant Benefit Scheme.