ABSTRACT
Objective: The hospital revenues are decreasing from the government policy in the universal coverage while increasing the hospital expenses . The cost analysis is a very important tool for the strategic plan in the hospital expenses reduction with standard quality. This study wanted to investigate the cost of 12 orthopaedic diseases using the clinical practice guideline (CPG) at maximum length of stay (LOS) and to compare the cost before and after utilization management in cost minimization analysis in orthopaedic inpatients under the universal coverage policy. Methods: Part 1, The CPG with maximum LOS was studied in detail and the cost analysis was performed using the formula C = S+I+X+P+O+L+A+R while C = unit service cost/case, S = service cost, I = instrument cost, X= X-ray cost, P = prosthetic cost, O = operating cost, L = laboratory cost, A = anesthetic cost, R = recovery room cost. Part 2, the cost minimization analysis (CMA) before and after utilization management was studied in 2 groups. Group A consisted of 236 cases which were studied after utilization management from June 1, 2003 to February 24, 2005. Group B consisted of 89 cases from June 1, 2002 to May 31, 2003 which were studied before utilization management was introduced in the department. The cost of both groups were compared. Results: The cost of the 12 orthopaedic diseases ranged from 13,036.10 baht/case for 3 days LOS in club foot surgery to 99,532.73 baht/case for 21 days LOS in total hip replacement surgery. The reduction of 1 day LOS reduces the service cost by an average 1,844.26 baht. The CMA found that after utilization management in group A, the CMA in the average cost reduction was 3,274.45 baht/case with an average 2.07 days reduction in length of stay. Both groups had the same outcomes. Conclusion: The cost analysis was done in 12 orthopaedic diseases using CPG. The usefulness with cost reduction was found after implementation of utilization management.
ABSTRACT
Objective: The purpose of this study was to determine the cost and unit cost of Dermasurgery Unit’s services through the perspective of a healthcare provider. Methods: This was a retrospective study, based on the database of the Department of Dermatology and the Department of Finance, Faculty of Medicine Siriraj Hospital, including labor cost, material cost, capital cost and number of patients from documents of Dermasurgery Unit and SAP system during April 1 – September 30, 2005. Unit cost calculation was based on the official method of Cost Controlling Unit, Department of Finance, Faculty of Medicine Siriraj Hospital. Results: The results demonstrated that the total direct cost of the Dermasurgery Unit was 1,302,798 baht. It composed of the labor cost of 690,752 baht, the material cost of 142,299 baht and the capital cost of 469,747 baht. Indirect cost of Dermasurgery Unit derived from 20% of the total direct cost was 260,560 baht. Finally, the full cost calculated by a summation of the total direct cost and the indirect cost was 1,563,359 baht. Unit cost of carbon dioxide (CO2) laser, Q-switched Nd:YAG laser, pulsed dye laser, skin biopsy, electrocautery and cryosurgery were 1,413.11 baht, 1,272.52 baht, 2,795.35 baht, 485.89 baht, 326.92 baht and 119.53 baht, respectively. The other treatments such as chemical peeling, intramuscular injection, intralesional corticosteroids injection, comedone extraction, wound dressing, trichloracetic acid application, suture removal, excision, iontophoresis and paring had the same unit cost of 115.15 baht. Conclusion: The study enabled us to know the unit cost of Dermasurgery Unit’s services which may be used as primary information for pricing strategy and resources allocation by the administrative board of the Department of Dermatology.