Costing analysis of an information & communications technology-enabled primary healthcare facility in India

Background & objectives: Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. Methods: We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. Results: The estimated overall annual cost of delivering health services through PHC in the public sector was ? 7.88 million. The additional economic cost of ICT was ? 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ? 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ? 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. Interpretation & conclusions: Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered.

Extracorporeal photopheresis in chronic graft-versus-host disease: clinical description and economic study

Abstract Introduction Although extracorporeal photopheresis (ECP) is a promising second-line therapy in the treatment of chronic graft-versus-host disease (cGVHD), its use is limited by its high cost. This study aims to describe the clinical evolution of patients who underwent ECP therapy for cGVHD and to perform an economic analysis of the therapy Methods This was a case series between 2016 and 2020 describing the clinical response to ECP and a micro-cost analysis of the therapy using time-driven activity-based costing. Results Six patients underwent ECP for corticosteroid-dependent cGVHD The cost per ECP session is 14,960.90 Brazilian reais (BRL), which primarily consists of the ECP kit with an activator (82.78%), followed by the hospital's physical structure (14.66%), human resources (2.48%) and exams/inputs (0.08%). The number of sessions performed ranged from 2 to 42. The total cost of the therapy per patient ranged from BRL 30,000 to 500,000. Conclusion The response of the patient with cGVHD to treatment with ECP was variable. These micro-costing results can be used to develop remuneration and cost control strategies in hematopoietic stem cell transplantation programs, as well as in further economic studies.

Custeio Baseado em Atividade e Tempo (TDABC) do modelo CEDMAC de terapia assistida para dispensação de medicamentos imunobiológicos para doenças reumatológicas no SUS / Time-Driven Activity Based Costing (TDABC) of the CEDMAC model of assisted therapy for dispensing immunobiological rheumatologic medications at SUS

Objetivos: Mensurar o custo dos procedimentos de infusão de imunobiológicos no modelo CEDMAC (Centro de Dispensação de Medicações de Alto Custo) e estimar o custo minimização integral gerada pela existência desse modelo. Métodos: A metodologia de Custeio Baseado em Atividade e Tempo (TDABC) foi usada para calcular os custos dos procedimentos. Tempos de atividades, capacidades máximas de atendimento e fluxos dos processos internos foram obtidos em entrevistas e validados por meio de acompanhamento de pacientes. Os procedimentos foram categorizados em três tipos: a) aplicação subcutânea, b) infusão endovenosa rápida e c) infusão endovenosa longa. O custo-minimização foi estimado a partir de análise de 2017 para pacientes com artrite reumatoide (AR). Resultados: Ao longo de 2019, foram realizados 12.074 atendimentos no CEDMAC. Desses atendimentos, 60% foram de aplicação subcutânea (custo de R$ 117,90), 30%, de infusão endovenosa rápida (custo de R$ 169,90) e 10%, de endovenosa longa (custo de R$ 217,50). Usando a análise realizada em 2017, foi possível calcular o custo-minimização integral do modelo (uma economia líquida estimada de R$ 1.258.024,26 ao ano) e também extrapolar esses valores para todo o SUS caso o modelo fosse difundido no país (uma economia líquida estimada de R$ 189.401.652,88). Conclusão: Utilizando o método de TDABC, foi possível realizar de maneira rápida e eficiente o custeio dos principais procedimentos realizados no modelo CEDMAC. Essa análise embasará a solicitação da incorporação desses procedimentos na tabela unificada do SUS. Caso os procedimentos sejam incorporados e o modelo CEDMAC, difundido pelo Brasil, estima-se que a economia gerada seja da ordem de 189 milhões de reais ao ano.

Objectives: To measure the costs of immunobiological infusion procedures in the CEDMAC model (Centro de Dispensação de Medicações de Alto Custo) and to estimate the full cost-minimization generated by the existence of this model. Methods: Time-Driven Activity Based Costing (TDABC) methodology was used to calculate the procedures costs. Activity times, service capacities and internal flows were obtained from employee interviews and validated by follow-up with patients. Procedures were categorized into three types: a) subcutaneous, b) intravenous fast infusion, and c) intravenous slow infusion. The full cost-minimization was estimated based on a 2017 analysis of the cost-minimization for rheumatoid arthritis (RA) patients. Results: In 2019, 12,074 patients were attended at CEDMAC. Of these, 60% of infusions were subcutaneous (costing R$ 117.90 each), 30% were fast intravenous infusion (costing R$ 169.90), and 10% were slow intravenous infusion (costing R$ 217.50). Using a 2017 RA analysis, it was possible to calculate the full cost-minimization of the model, with an estimated net savings of R$ 1,258,024.26 per year. The estimated net savings if the model were disseminated throughout the country for the entire SUS would be R$ 189,401,652.88. Conclusion: Using the TDABC method it was possible to quickly and efficiently estimate the cost allocation of the main procedures performed in the CEDMAC model. This analysis will support the request for incorporating these procedures into SUS. If the procedures were incorporated, and the CEDMAC model was disseminated throughout Brazil, the savings generated by this initiative could be up to 189 million reais per year.

Custeio Baseado em Atividade e Tempo (TDABC) em um Departamento de Endoscopia de um hospital privado / Time-driven Activity-based Costing (TDABC) in an Endoscopy Department of a private hospital

Contexto: A gestão da saúde baseada em valor (VBHC) vem sendo a estratégia de diversas instituições de saúde no mundo todo, como forma de melhorar a qualidade dos serviços entregues de forma sustentável. Medir os resultados em saúde e custos é fundamental para a manutenção do VBHC e é um passo essencial para a sua implementação. Objetivo: O objetivo deste estudo de caso é retratar a aplicação do método TDABC em um procedimento de endoscopia ambulatorial com colonoscopia de um hospital privado do Sul do Brasil. Métodos: Este estudo aplicou o método Time-driven Activity-based Costing (TDABC) como técnica de microcusteio em um centro da saúde suplementar brasileira para avaliar o custo de procedimentos realizados na endoscopia. Foram analisados descritivamente os custos e tempos dos procedimentos e identificados os recursos e atividades de maior representatividade financeira. Por fim, foi feita uma comparação entre o custo aferido e a taxa de reembolso dos procedimentos. Resultados: O custo por procedimento apurado por meio do método é de R$ 684,77, e seu valor de reembolso médio é de R$ 993,91, mostrando-se lucrativo para a instituição. Conclusões: A aplicação do TDABC gerou melhor entendimento sobre todos os custos envolvidos no procedimento e representa o primeiro passo para a difusão do método aos demais processos e departamentos do hospital.

Context: Value-based health management (VBHC) has been the strategy of several health institutions around the world, as a way to improve the quality of services delivered in a sustainable way. Measuring health outcomes and costs is critical to maintaining the VBHC and is an essential step in its implementation. Objective: The objective of this case study is to portray the application of the TDABC method in an outpatient endoscopy procedure with colonoscopy in a private hospital in southern Brazil. Methods: This study applied the Time-driven Activity-based Costing (TDABC) method as a microcosting technique in a Brazilian supplementary health center to assess the cost of procedures performed in endoscopy. The costs and times of the procedures were descriptively analyzed and the resources and activities of greater financial representation were identified. Finally, a comparison was made between the measured cost and the reimbursement rate of the procedures. Results: The cost per procedure calculated using the method is R$ 684.77, and its average reimbursement value is R$ 993.91, proving to be profitable for the institution. Conclusions: The application of TDABC generated a better understanding of all the costs involved in the procedure and represents the first step towards disseminating the method to other hospital processes and departments.

The cost of total hip replacement: a multicentric TDABC comparison in Brazil / O custo da artroplastia de quadril: uma comparação multicêntrica TDABC no Brasil

Objective: Monitoring costs is critical in searching for a more effective healthcare system. This study aimed to comprehend the care pathway and measure the costs associated with hip replacement surgeries in different hospitals in Brazil. Methods: The time-driven activity-based costing method was applied for cost data collection and analyses. Data on 62 patients were retrieved from five public hospitals. A descriptive cost analysis was followed by a comprehensive analysis of the variability in each hospital's care process, leading to suggestions for cost-saving opportunities along with the surgical care pathway. As a final analysis, the cost of surgical treatment was contrasted with the national reimbursement fee. Results: The mean cost per patient of the total sample was $5,784 (MIN-MAX $2,525.9-$9,557.8). Pre- and post-surgery hospitalization periods demonstrated the highest variability in length of time and resource consumption among centers. Compared to the national best practice fee, the average cost per inpatient total hip arthroplasty (THA) pathway from all six hospitals was approximately 7x the national reimbursement. Conclusion: The application of the TDABC allowed us to identify differences in the surgical care pathway among hospitals, which could be explored in further studies aimed at designing a benchmark surgical pathway. Differences in how the treatment is delivered to patients also justified the high-cost variability among centers.

Objetivo: O custo do monitoramento é um elemento-chave na busca contínua por um sistema de saúde mais eficaz. O objetivo deste estudo foi compreender a trajetória assistencial e mensurar os custos associados às cirurgias de artroplastia do quadril em diferentes hospitais do Brasil. Métodos: O método de custeio baseado em atividades orientado pelo tempo foi aplicado para a coleta e análise de dados de custos. Os dados de 62 pacientes foram recuperados de cinco hospitais públicos. Uma análise descritiva de custos foi seguida por uma análise abrangente da variabilidade no processo de atendimento de cada hospital, levando a sugestões de oportunidades de redução de custos junto com a via de atendimento cirúrgico. Como análise final, o custo do tratamento cirúrgico foi contrastado com o valor de reembolso nacional. Resultados: O custo médio por paciente da amostra total foi de $ 5.784 (MIN-MAX $ 2.525,9-$ 9.557,8). Os períodos de internação pré e pós-operatórios demonstraram a maior variabilidade no tempo e no consumo de recursos entre os centros. Em comparação com o reembolso nacional de melhores práticas, o custo médio por cirurgia de prótese de quadril de paciente internado de todos os seis hospitais foi de aproximadamente 7x o reembolso nacional. Conclusão: A aplicação do TDABC nos permitiu identificar diferenças na via de atendimento cirúrgico entre hospitais, o que poderia ser explorado em estudos futuros que visem projetar uma via cirúrgica de referência. As diferenças na forma como o tratamento está sendo entregue aos pacientes também contribuíram para justificar a alta variabilidade dos custos entre os centros.

Cost of providing family planning services & management of pregnancy outcomes at public health facilities in India

Background & objectives: Lack of costing data is a critical gap that exists in the field of family planning (FP) in India. The aim of this study was to estimate health system costs of FP in India for existing modern methods, and potential newer methods (etonorgestrel implant and levonorgestrel intrauterine device) and pregnancy-related services in India. Methods: A bottom-up micro-costing study was conducted in five public health facilities of an Indian State. Data of last one year were collected from existing hospital records and hospital staff was interviewed. Collected data were analyzed using standard costing methods. Results: Package costs of delivering FP services ranged from ? 807 (95% CI 685, 931) for condoms and ? 10,539 (8796, 12269) for tubal ligation. Estimates of etonorgestrel implant and levonorgestrel intrauterine system were ? 3,200 (2800, 3625) and 3,426 (3232, 3623). Cost of antenatal care along with vaginal delivery, caesarean and abortion were ? 10,916 (8744, 13078), 22,136 (17570, 26910) and 8,574 (6791, 10379), respectively. One way sensitivity analysis showed that the three most influential factors on the costs of FP services were prices of drugs and consumables, number of beneficiaries and health personnel cost. Interpretation & conclusions: The present study has generated package costs for FP and pregnancy-related services in India which could be used by publicly-fu

Transplante cardíaco no Hospital das Clínicas da Universidade Federal de Minas Gerais: custo do paciente internado / Cardiac transplantation at the Hospital das Clínicas of the Federal University of Minas Gerais: inpatient cost

Este trabalho teve como objetivo identificar o custo do paciente internado para transplante cardíaco no Hospital das Clínicas da Universidade Federal de Minas Gerais nos anos de 2019 e 2020. Por meio da metodologia de custeio ABC e Diagrama de Pareto foram levantados os valores inerentes aos materiais, medicamentos e exames realizados pelos pacientes no período de internação em que ocorreram os transplantes. Também foram investigados os custos referentes ao tempo disponibilizado pela equipe cirúrgica e os custos relativos aos dias de internação em Unidade de Terapia Intensiva e Enfermaria. O método de pesquisa envolveu estudo de caso e pesquisa documental, especialmente prontuários físicos e eletrônicos dos pacientes, nos quais foram verificados os registros de dados clínicos. Os preços dos materiais, medicamentos e exames foram obtidos em bancos de dados utilizados pelo hospital como: Comprasnet, Banco de Preços, Painel de Preços e sistemas internos de gestão de compras. Os custos de internação foram levantados junto ao setor responsável pela apuração de custos do HC-UFMG, enquanto as informações utilizadas para cálculo do custo da equipe cirúrgica são provenientes do Portal da Transparência do Governo Federal e plano de cargos, carreiras e salários da Empresa Brasileira de Serviços Hospitalares e UFMG. Alcançado o objetivo foi produzido relatório situacional, que poderá ser utilizado pelas instituições de saúde como referência de pesquisa e negociação com os entes responsáveis pelo financiamento da saúde no Brasil, principalmente dos transplantes cardíacos. A pesquisa se mostrou relevante do ponto de vista clínico e de gestão, possibilitando uma visão sistêmica e integrada dos processos, à medida que amplia o conhecimento dos custos de uma importante linha de cuidado, além de contribuir com o redimensionamento de recursos e dar mais subsídios à tomada de decisão. Os resultados mostraram que no Hospital das Clínicas da UFMG o Custo do Transplante Cardíaco é de R$ 141.958,91.

This study aimed to identify the cost of patients hospitalized for heart transplantation at the Clinical Hospital of the Federal University of Minas Gerais in the years 2019 and 2020. Through the ABC costing methodology and Pareto's Diagram, the values inherent to the materials, drugs and diagnostic procedures to which the patients were submitted during the period of hospitalization for the transplant were raised. The costs related to the time made available by the surgical team and the costs related to the days of hospitalization in the Intensive Care Unit and ward were also investigated. The research method involved case study and documental research, especially physical and electronic patient records, in which clinical data records were verified. The prices of materials, medicines and exams were obtained from databases used by the hospital such as: Comprasnet, Price Bank, Price Panel and internal purchasing management systems. The hospitalization costs were collected from the sector responsible for calculating the costs of the HC-UFMG, while the information used to calculate the cost of the surgical team comes from the Federal Government's Transparency Portal and the and Empresa Brasileira de Serviços Hospitalares and UFMG's career and salary plan. Having achieved the objective, a situational report was produced, which can be used by health institutions as a reference for research and negotiation with the entities responsible for health financing in Brazil, especially heart transplants. The research proved to be relevant from a clinical and management point of view, enabling a systemic and integrated view of the processes, as it expands the knowledge of the costs of an important line of care, in addition to contributing to the resizing of resources and providing more subsidies to decision making. The results showed that at the Hospital das Clínicas da UFMG the cost of Heart Transplantation is R$ 141.958,91.

Sistema de costos para la carrera de Licenciatura en Enfermería en Cienfuegos. Curso 2017-2018 / Cost system for the Bachelor of Nursing career in Cienfuegos. Course 2017-2018

RESUMEN Fundamento el conocimiento del comportamiento de los costos en los servicios de salud es de vital importancia, con vistas a realizar una planificación eficiente de recursos. La Universidad de Ciencias Médicas de Cienfuegos aún no cuenta con un sistema que permita calcular y analizar los costos por estudiantes, en específico para la Licenciatura en Enfermería. Objetivo diseñar un sistema de costos para estudiantes de Licenciatura en Enfermería. Métodos se realizó un estudio observacional, descriptivo y transversal, en el que se efectuó una evaluación económica parcial de tipo descripción de costos. Se aplicó el método de costo modelado por estudiante de la Licenciatura en Enfermería, en la Universidad de Ciencias Médicas de Cienfuegos, desde la perspectiva del Sistema Nacional de Salud y para un horizonte temporal de un curso académico (2017 - 2018). Se utilizó el método escalonado, a partir de un instrumento para controlar los costos institucionales. Se combinaron técnicas y herramientas en la obtención de datos, tales como entrevistas a especialistas, consulta de documentos económicos y estadísticos. Resultados se diseñó un sistema de costos por áreas de responsabilidad. Predominaron los costos directos (5 799.00 pesos), mientras que los centros de costos con mayor contribución fueron el Decanato y Departamento de Cultura Física. El costo total por estudiante fue de 8072.00 pesos. Conclusión el costo de un estudiante de Licenciatura en Enfermería representa un gasto económico significativo en la Universidad de Ciencias Médicas de Cienfuegos. Este tipo de análisis posibilita identificar aspectos sobre los cuales actuar, con el fin de ahorrar y distribuir mejor los recursos.

ABSTRACT Background knowledge of costs in health services behavior is of vital importance, in order to carry out efficient planning of resources. The Cienfuegos University of Medical Sciences does not yet have a system that allows calculating and analyzing costs per student, specifically for the Bachelor of Nursing. Objective to design a cost system for undergraduate students in Nursing. Methods an observational, descriptive and cross-sectional study was carried out, in which a partial economic evaluation of the costs description was carried out. The modeled cost method per student of the Nursing Degree was applied, at the Cienfuegos University of Medical Sciences, from the perspective of the National Health System and for a time horizon of one academic year (2017 - 2018). The stepped method was used, based on an instrument to control institutional costs. Techniques and tools were combined to obtain data, such as interviews with specialists, consultation of economic and statistical documents. Results a cost system was designed by areas of responsibility. Direct costs (5,799.00 pesos) predominated, while the cost centers with the highest contribution were the Dean and Department of Physical Culture. The total cost per student was 8072.00 pesos. Conclusion the cost of a Bachelor of Nursing student represents a significant economic expense at the Cienfuegos University of Medical Sciences. This type of analysis makes it possible to identify aspects on which to act, in order to save and better distribute resources.

Overdentures as an alternative to conventional dentures: a micro-costing analysis for Public Health Service in Brazil / Overdentures como alternativa às próteses convencionais: uma análise de micro-custeio para o Sistema Único de Saúde

Abstract This study aimed to estimate cost and compatibility with public financial incentives of two technologies for treating the edentulous mandible: lower complete dentures (CD) and overdentures retained by two dental implants (OD). This study consisted of a partial economic evaluation, with a micro-costing bottom-up approach for the calculation of direct costs. The estimates involved the number of consultations, proportion of materials, equipment, instruments' lifetime, and human resources, described in the price panel website of the Ministry of Economy in Brazil. Complementary information was obtained from a panel of experts. A sensitivity analysis was based on 20% variation. The estimated cost of a CD was R$ 189.89 (base scenario), and this varied between R$ 151.91 and R$ 227.89 according to sensibility analysis. The cost of an OD was R$ 663.05 (ranging from R$ 795.66 to R$ 530.44 - 1US=R$ 3.80/July 2019). The Ministry of Health covers appropriately the costs of the CD and OD. Both technologies showed costs that are within the limits of financial public incentives obtained by municipalities. The technologies are economically viable and should be induced through public policies due to their positive impacts on several functional domains of health.

Resumo Estimar os custos e a compatibilidade dos incentivos públicos de duas tecnologias para o tratamento da mandíbula edêntula: prótese total convencional (PTC) e overdenture retida por dois implantes (OD). Este estudo consistiu em uma avaliação econômica parcial, com abordagem "bottom-up" para o cálculo dos custos diretos. As estimativas levaram em consideração o número de consultas, proporção de materiais, equipamentos, vida útil dos instrumentais e recursos humanos. Os custos foram baseados no painel de preços do Ministério da Economia do Brasil e informações complementares foram obtidas de um painel de especialistas. Uma análise de sensibilidade foi baseada na variação de 20% dos custos. Os custos da PTC foram estimados em R$ 189,89 (cenário base) com variação entre R$ 151,91 e R$ 227,89 na análise de sensibilidade. Os custos da OD foram R$ 663,05 (variando de R$ 795,66 a R$ 530,44). O Ministério da Saúde cobre apropriadamente os custos de ambas as tecnologias nos cenários base e mais otimista. Ambas as tecnologias apresentaram custos dentro dos limites dos incentivos públicos recebidos. As tecnologias são economicamente viáveis e devem ser induzidas por políticas públicas diante do impacto positivo em vários domínios funcionais da saúde.

The use of micro-costing in an economic analysis of allogeneic HSCT in Brazil / O uso do microcusteio na análise econômica do TCTH alogênico no Brasil

Objetivo: O objetivo deste estudo foi estimar os custos do tratamento do transplante de células--tronco hematopoéticas (TCTH) em um centro de referência no Brasil. Métodos: A população do estudo foi composta por pacientes provenientes da lista de TCTH do Sistema Único de Saúde submetidos ao TCTH em um hospital do sul do Brasil, entre 2016 e 2019. A avaliação de custos foi realizada por meio de um estudo de microcusteio, baseado no Time-Driven Activity-based Costing (TDABC) adaptado para estudos econômicos em saúde e incluiu as seguintes etapas: definição da questão de pesquisa, coleta de dados estruturada e análise estatística dos resultados. Resultados: O custo total do TCTH foi de $ 155.110 ($ 92.794 ­ $ 249.146 USD). O TCTH de doador não aparentado compatível foi mais caro do que o TCTH de doador aparentado compatível. Os principais fatores de custo envolvem complicações pós-transplante, principalmente a ocorrência de infecções. Em relação à composição dos custos, exames e procedimentos representam o maior custo em TCTH (45%). Conclusão: Essas estimativas podem ser aplicáveis a novas avaliações de custo-efetividade do TCTH e ajudar os gestores na tomada de decisão em saúde, especialmente em países de média renda

Objective: The objective of this study was to estimate treatment costs of Hematopoietic stem cell transplantation (HSCT) at a reference center in Brazil. Methods: The study population consisted of patients from the Unified Health System HSCT who underwent HSCT in southern Brazil between 2016 and 2019. Costs were measured using a micro-costing approach, based on Time-Driven Activity-based Costing (TDABC) adapted for economic studies in health and included the following steps: definition of the research question, structured data collection, and statistical analysis of results. Results: The total cost of HSCT was $155,110 ($92,794 ­ $249,146 USD). Matched unrelated donor HSCT was more expensive than matched related donor HSCT. The major cost factors involve post- -transplant complications, mainly the occurrence of infections. Concerning cost composition, exams and procedures represent the largest expense in HSCT (45%). Conclusion: These estimates could be applicable to further evaluations for HSCT cost-effectiveness and help healthcare decision-makers in middle-income countries

Awareness about the concept of Activity Based Costing (ABC) among medical laboratory Professionals

Background: Medical laboratories are an integral and essential component of the healthcare system. Information about costing and resource management is of paramount importance for providing services at a reasonable price and without quality compromise. Awareness of a scientific method of cost accountingActivity Based Costing (ABC), may contribute significantly to enhance the laboratories capacity to manage its resources efficiently. Objective: This study was done to know the awareness of Activity based costing. Materials & Methods: A preformed validated questionnaire was sent to various laboratory professionals affiliated to private and teaching hospital laboratories. 121 responses were recorded, percentages of which were entered in EXCEL sheets, graphically represented and analysed. Results: Majority of our participants were from medium sized laboratories (40%), working in private sectors, using a combination of automated & semi-automated technologies & not being accredited by regulating bodies. Activity based costing was being implemented in only 14 labs, with more than 70% of respondents not having an adequate knowledge about the same. Inadequate training (44.6%), not being involved in costing (46.3%) and assumed practical difficulties in implementing (9.1%) were some of the reasons cited. Conclusion: Healthcare providers from the laboratory had limited awareness on costing methods like ABC. Efforts to implement and create awareness about the same if made can upscale quality, and sustainable service delivery in lab services at reasonable costs especially in developing country like ours.

Relationship among productive and economic variables of beef cattle in Brazil / Relações entre variáveis produtivas e econômicas de bovinocultura de corte no Brasil

ABSTRACT: The present study aimed to obtain, through statistical methods, the independent variables that influence the economic and productive results of Brazilian beef cattle. Economic and productive information was collected from 106 farms in Brazil. Data collection was performed by the Instituto de Métricas Agropecuárias (Inttegra). The variable selection method used was stepwise regression followed by polynomial regression analyses. The variable beef cattle economic result showed the positive effect of disbursement per head per month and average weight gain. An average daily gain of 520 g in live weight was obtained, and this variable was influenced especially by nutrition cost. The arroba production (arroba is a unit of weight corresponding to 15kg) was influenced by the linear effect of nutrition cost and stocking rate. The variable arroba production in pasture showed a linear and positive effect of average weight gain in pasture and stocking rate in pasture. For profit per arroba, the variables nutrition cost, disbursement with pasture, and average sale price had a linear effect. The independent variables that had the greatest influence on the response variables were stocking rate, average daily weight gain, and nutrition cost. Thus, increases in investment in nutrition and stocking rate should result in higher production rates and improvements in the profitability of this activity.

RESUMO: O presente trabalho teve como objetivo obter, por meio de métodos estatísticos, quais variáveis independentes influenciam as variáveis econômicas e produtivas na bovinocultura de corte brasileira. O banco de dados utilizado foi obtido por coleta de informações econômicas e produtivas em 106 fazendas no Brasil. O método de coleta de dados foi definido pelo Instituto de Métricas Agropecuárias (Inttegra). Foram realizadas análises de seleção de variáveis pelo método Stepwise, seguido por análises de regressão múltipla. A variável resultado econômico da bovinocultura de corte teve efeito positivo do desembolso mensal por cabeça e do ganho de peso médio diário. Para o ganho de peso médio diário foi obtido um valor médio de 520 gramas, e esta variável foi influenciada principalmente pelo custeio com nutrição. Para a produção de arroba foi obtido efeito linear do custeio com nutrição e da taxa de lotação. Para a variável produção de arroba a pasto foi obtido um efeito linear e positivo do ganho médio diário de peso no pasto e da taxa de lotação no pasto. Para o lucro por arroba, as variáveis custeio com nutrição, desembolso com pastagem e preço médio de venda tiveram efeito linear. As variáveis independentes que tiveram maior influência nas variáveis resposta foram a taxa de lotação, o ganho médio diário de peso e o custeio com nutrição. Assim, aumentos no investimento em nutrição e na taxa de lotação dos animais devem resultar em maiores índices de produção e em melhorias na rentabilidade da atividade.

An Assessment of Epidemiologic Burden of Hospitalization for Bronchial Asthma in Acute Exacerbation among Adult Patients Admitted in a Tertiary Hospital in the Philippines: A Pilot Study

@#Objective. This pilot study aimed to determine the epidemiologic burden of hospitalization for bronchial asthma in acute exacerbation. Methods. We used a descriptive cross-sectional study to describe the demographic profile, comorbidities and level of control of patients admitted for bronchial asthma in acute exacerbation admitted to the Philippine General Hospital from May 1 to October 31 2019. The study computed for the admission rate and compared the average cost of hospitalization (diagnostics, therapeutics and room) using direct costing to the total reimbursable cost from PhilHealth. Associations between patient characteristics (age, type of admission) and hospitalization cost were also determined. Results. We enrolled 45 patients in the study. The admission rate was 8/month. The mean cost of admission was significantly higher than the reimbursable amount from PhilHealth (Php 20,074.63 versus Php 9000) (p = 0.004). Cost of hospitalization was significantly higher in pay patients versus charity (p = 0.001 for diagnostics, p = 0.005 for treatment and p = 0.001 for room cost), in patients with poorly controlled asthma (p = 0.020 for diagnostics and p = 0.014 for room cost) and those with frequent short-acting beta-agonist (SABA) use (p = 0.001). Conclusion. Asthma remains an economic burden for the Filipino patient. Persistent SABA use, perceived asthma control of patients and increased expenses associated with an asthma exacerbation admission lead to significant out-of-pocket expenditure.

Aplicação do método de custeio baseado em atividade e tempo (TDABC) em uma Instituição de Longa Permanência de Idosos (ILPI) / The application of time-driven activity-based costing in an Elderly People Institution

Objetivos: O envelhecimento da população brasileira é caracterizado por ser um processo progressivo e crescente. A necessidade de gerenciamento econômico robusto dos serviços disponibilizados à saúde do idoso torna-se imprescindível. O objetivo deste estudo foi avaliar a estrutura de gestão de custos de uma Instituição de Longa Permanência de Idosos (ILPI). Métodos: As orientações para a aplicação do método de custeio baseado em atividade e tempo (TDABC) foram utilizadas como método de análise de custos. Os dados dos anos de 2018 e 2019 foram considerados para formar as análises e viabilizar a compreensão dos diferentes graus de consumo de recursos, durante o ciclo de cuidados da ILPI. Resultados: A aplicação da metodologia estimou o custo unitário de cada residente considerando o seu grau de dependência devido a sua condição clínica. Pôde-se identificar pontos de melhorias gerenciais, com ênfase na revisão da alocação das capacidades de hospedagem. Conclusões: O TDABC, como uma metodologia de fácil aplicação para estruturação dos custos relacionados a cada paciente, traz resultados oportunos para a melhor gestão e otimização de recursos em organizações de saúde. Sugere-se para trabalhos futuros a aplicação de um estudo de precificação dos serviços da ILPI, de modo que essa possa pautar os valores de mensalidades cobradas em bases mais sólidas.

Objectives: The need for a robust management of services focus on the elderly health becomes essential. The objective of this study was to evaluate the costs structure of an Elderly Long Term Care Institution (ILPI). Methods: The literature orientations for the application of the time-driven activity-based costing (TDABC) were used as a cost analysis method. Data from 2018 and 2019 were considered to form the analyzes and enable the understanding of the different degrees of resource consumption during the LTCI care cycle. Results: The application of the methodology estimated the unit cost of each resident considering their degree of dependence due to their clinical condition. Management improvement points could be identified, with emphasis on the review of hosting capacity allocation. Conclusions: TDABC as an easily applied methodology that brings timely results for better resource management and optimization in healthcare organizations. It is suggested for future researches the application of a pricing study of the services of ILPI, so that it can guide the monthly fees charged on a better substantiated basis.

Cost accounting of telemedicine service items based on improved activity-based costing / 中华医院管理杂志

Telemedicine can optimize deployment of medical resources and minimize diagnosis discrepancies.Formulation of a rational project pricing and scientific compensation policy will be conducive to its future development. The concept of human resource consumption in RBRVS was used as reference to improve the activity-based costing ( ABC ) method. The authors sorted out the resource cost repository, identified the activity system, classified the motivation resources into respective activity cost repositories, and calculated the cost of respective cost object distribution.The cost of three telemedicine service items(remote single discipline consultation, remote image consultation and remote pathology consultation were 119.69, 147.03 and 161.61 yuan respectively) was calculated by the improved ABC.It can better indicate project costs than that calculated by the traditional ABC(137.30, 147.17 and 144.08 yuan), and proves more consistent with the existing prices of other province(134.00, 150.00 and 174.00 yuan).

The Cost of Radiology Procedures Using Activity Based Costing (ABC) for Development of Cost Weights in Implementation of Casemix System in Malaysia / Jurnal Sains Kesihatan Malaysia

@#Presently there is a gross lack of information on cost and cost weights in many developing countries that implementcasemix system. Furthermore, studies that employed Activity Based Costing method (ABC) to estimate the costs of radiologyprocedures were rarely done in developing countries, including Malaysia. The main objective of this study is to determinethe costs of radiology procedures for each group in casemix system, in order to develop cost weights to be used in theimplementation of the casemix system. An economic evaluation study was conducted in all units in the Department ofRadiology in the first teaching hospital using the casemix system in Malaysia. From the 25,754 cases, 16,173 (62.8%)of them were from medical discipline. Low One Third and High One Third (L3H3) method was employed to trim theoutlier cases. Output from the trimming, 15,387 cases were included in the study. The results revealed that the totalinpatients’ charges of all the radiology procedures was RM1,820,533.00 while the cost imputed using ABC method wasRM2,970,505.54. The biggest cost component were human resources in Radiology Unit (Mobile) (57.5%), consumables(78.5%) of Endovascular Interventional Radiology (EIR) Unit, equipment (81.4%) of Magnetic Resonance Imaging (MRI)Unit, reagents (68.1%) of Medical Nuclear Unit. The one highest radiology cost weight, was for Malaysia DiagnosisRelated Group (MY-DRG®)B-4-11-II (Hepatobiliary and Pancreas Neoplasms with severity level II, 2.8301). The methodof calculation of the cost of procedures need to be revised by the hospital as findings from this study showed that the costimposed to patient is lower than the actual cost.

Sistema de apuração e gestão de custos dos hospitais próprios da Secretaria de Estado da Saúde do Paraná / System of calculation and cost management of the own hospitals of the State Department of Health of Paraná

A pesquisa envolveu um grande desafio da saúde pública no Brasil: o financiamento da saúde frente a um Sistema Único de Saúde com direitos universais e abrangentes e os custos a ele inerentes. Os hospitais públicos de administração direta ou indireta apresentam uma faixa de custos importante no Sistema Único de Saúde, além de apresentarem uma complexidade maior dentro do sistema. O objetivo foi o desenvolvimento de uma metodologia para definir um sistema de apuração e gestão de custos hospitalares aplicados aos Hospitais próprios da Secretaria da Saúde.Trata-se de uma pesquisa-ação com base no levantamento de resultados de pesquisas similares para análise da aplicação do modelo de custeio para organizações hospitalares, bem como a análise empírica das informações existentes em dois hospitais selecionados. A aplicabilidade direta da pesquisa foi estabelecer uma metodologia de sistema de custeio para hospitais públicos do Paraná que pode ser replicada as diferentes unidades a partir de um conjunto de ferramentas disponibilizadas. Assim, o alcance inicial foi relativo ao Sistema Hospitalar Público do Paraná, que compõe19 hospitais administrados diretamente pelo estado, distribuídos nas 22 regiões de saúde e com diferentes perfis de atendimento. Contudo,este mesmo sistema pode ser replicado para todos os hospitais públicos das diferentes unidades da Federação. Um dos pontos fortes do modelo proposto é o seu potencial de implantação de forma simples e organizada,sem que para isso tenha que se possuir uma grande estrutura funcional ou tecnológica para a sua aplicação.

The research involved a major public health challenge in Brazil: health financing versus a Single Health System with universal and comprehensive rights and the inherent costs. Public hospitals of direct or indirect administration present an important cost range in the Unified Health System, in addition to presenting a greater complexity within the system. The objective was the development of an applied methodology fora system of calculation and management of hospital costs applied to the proper Hospitals of the Department of Health. It is an action research based on the survey of similar research results to analyze the application of the model of costing for hospital organizations, as well as the empiricalanalysis of existing information in two selected hospitals. The direct applicability of the research was to establish a methodology of costingsystem for public hospitals of Paraná that can be replicated the differentunits from a set of tools made available. Thus, the initial scope wasrelated to the Public Hospital System of Paraná, which comprises 19hospitals directly administered by the state, distributed in the 22 healthregions and with different service profiles. However, this same systemcan be replicated to all public hospitals of the different units of theFederation. One of the strengths of the proposed model is its implantation potential in a simple and organized way, without having to have alarge functional or technological structure for its application.

Estimation Of Cost Of Diagnostic Laboratory Services Using Activity Based Costing (ABC) For Implementation Of Malaysia Diagnosis Related Group (My-Drg®) In A Teaching Hospital

The Malaysia Diagnosis Related Group (MY-DRG®), established since 2002, is a patient classification system that stratifies disease severity and categories patients into iso-resource groups. Casemix can be used to estimate costs per episode of care and as a provider payment tool in health services. Casemix has also been used to enhance quality and improve the efficiency of health services. Hence, estimation cost per DRG is important especially in developing countries where costing data are still scarce. We embarked on a study to determine the costs of the diagnostics laboratory services for each MY-DRG® based on the severity of illnesses. Most costing studies for diagnostic laboratory services usually focus on the cost of consumables and equipment alone and employed the step-down costing method. Very few studies applied Activity-Based Costing (ABC) method to estimate the costs for diagnostic laboratory services. This study was done with the purpose of developing the diagnostics laboratory cost using the ABC method. All medical cases discharged from UKM Medical Centre (UKMMC) in 2011 grouped into MY-DRG® were included in this study. In 2011, a total of 2.7 million diagnostic laboratory investigations were carried out in the Department of Diagnostic Laboratory Services in UKMMC. ABC was conducted from January to December 2013 in all units of the department. Cost of 242 types of diagnostic laboratory services were collected using a costing format. Out of 25,754 cases, 16,173 (62.8%) cases were from the medical discipline. After trimming using L3H3 method, 15,387 cases were included in the study. Most of the cases were on severity level one (44.6%), followed by severity level two (32.3%) and severity level three (23.1%). The highest diagnostic laboratory service weight was for Lymphoma & Chronic Leukemia, severity level III (C-4-11-III) with the value of 5.9609. Information on seven cost components was collected form each procedure: human resources, consumables, equipment, reagents, administration, maintenance and utilities. The results revealed that, the biggest cost component for human resources was in Molecular Genetic Unit (89.6%), consumables (34.8%) from Tissue Culture Unit, equipment (11.2%) and reagents (68.1%) from Specialized Haemostasis Unit. In conclusion, the accurate and reliable cost of the diagnostic laboratory services can be determined using ABC. Top management of the department should be able to use the output of the study to take appropriate steps to reduce unnecessary wastages of resources in the various units of the services.

Costing of immunization service provision in Kalutara district, Sri Lanka: a crosssectional study.

Background: Immunization is regarded as the single most cost-effective way to prevent vaccine-preventable diseases. With the rising cost of the National Immunization Programme (NIP) in Sri Lanka, immunization costing studies could help programme managers to ensure sustainable immunization financing in the country. Methods: Four medical officer of health (MOH) divisions in Kalutara district were included, to estimate the cost incurred for the NIP programme. Fifteen immunization clinics from urban and rural settings were selected from the selected MOH divisions, by a simple random sampling method. Data were collected for a period of 3 months, using pretested check-lists. In addition, related data at national and district levels were also collected. Cost estimates were made for direct capital and recurrent costs. Results: The cost of vaccines under the national immunization schedule for infants was 1361.84 SL Rs (US$ 10.32). For children under 5 years of age, it was 1535.64 SL Rs (US$ 11.63). The majority of these costs were direct recurrent costs (93.4%). Vaccines (84.3%) and staff salaries (6.4%) were the main components of direct recurrent costs, while cold-chain equipment (5.3%) was the main contributor to direct capital cost. Conclusion: The cost of vaccine is the highest proportion among all other cost components in the NIP in Sri Lanka, and this is largely attributable to new costly vaccines. Staff payments are not significant, as they are a shared cost of public health service providers. Studies exploring the costing of the NIP in the country would be beneficial, to ensure sustainable immunization financing.

Cost of healthcare-associated infection management in a tertiary first-class hospital / 中国感染控制杂志

Objective To explore the cost of healthcare-associated infection (HAI)management in a tertiary first-class hospital,provide data support for cost-effectiveness and cost-benefit analysis of HAI management,and provide scientific evidence for the rational allocation of hospital resources.Methods Micro-costing study was used to calcu-late the direct cost of the department of HAI management by collecting the quantity and unit price of each item. Results The total cost of HAI management in this hospital in 2013 were about ￥870 000,including human cost￥790 000,depreciated fixed assets ￥34 501 ,low-value consumption goods ￥3 800,publicity and training￥33 600,office consumables ￥5 208;average cost were ￥12.16 per person and ￥529.69 per bed.Conclusion Human cost is the main cost in HAI management in this hospital.