Costeo basado en actividades: una metodología de gestión en tratamientos intensivos / Activity-based costing methodology to manage resources in intensive care units

Background: An accurate estimation of resources use by individual patients is crucial in hospital management. Aim: To measure financial costs of health care actions in intensive care units of two public regional hospitals in Chile. Material and Methods: Prospective follow up of 716 patients admitted to two intensive care units during 2011. The financial costs of health care activities was calculated using the Activity-Based Costing methodology. The main activities recorded were procedures and treatments, monitoring, response to patient needs, patient maintenance and coordination. Results: Activity-Based Costs, including human resources and assorted indirect costs correspond to 81 to 88% of costs per disease in one hospital and 69 to 80% in the other. The costs associated to procedures and treatments are the most significant and are approximately $100,000 (Chilean pesos) per day of hospitalization. The second most significant cost corresponds to coordination activities, which fluctuates between $86,000 and 122,000 (Chilean pesos). Conclusions: There are significant differences in resources use between the two hospitals studied. Therefore cost estimation methodologies should be incorporated in the management of these clinical services.

Medicina intensiva en Chile: desafíos para su desarrollo. Documento de la Comisión Nacional de Medicina Intensiva del Ministerio de Salud / Ministry of Health Intensive Care Medicine Commission: Proposals for the development of the discipline

Intensive care medicine in Chile is still in its dawn. It has experienced a progressive growth in the last decade, but continues to be weak. Although investments in the discipline have increased fivefold, there is still a severe deficiency of intensive care specialists. This issue will represent a serious problem in the near future. The Ministry of Health gathered an expert committee to study the problem and propose solutions for the future development of the discipline.

Estudio retrospectivo de costos de tratamientos intensivos por paciente y día cama / Calculation of costs per inpatient day in an intensive care unit

Background: Intensive medicine is especially expensive and requires an efficient management. Aim: To measure the real costs of diseases treated in an intensive care unit and compare them with the costs assigned by the Chilean National Health Fund (FONASA) for 2008. Material and Methods: Retrospective review of 225 patients, representing 82 percent of discharges from an intensive care unit during 2008. Patients were classified according to their medical conditions as having sepsis, trauma, cardiovascular, respiratory or neurological diseases. Costs were calculated using the cost per activity system. Results: Trauma, sepsis and cardiovascular diseases had the greatest cost per inpatient day, corresponding to 294,779; 253,513 and 244,713 Chilean pesos, respectively. Seventy percent of costs correspond to human resources followed by complementary examinations, that represent up to 15 percent of costs. Patients with sepsis and cardiovascular diseases absorbed 28 and 26 percent of intensive care unit resources, respectively. Patients who died with these diseases absorbed 35 and 16 percent of resources, respectively. Conclusions: All diseases studied had significantly higher costs than those assigned by the National Health Fund.