Bayati Mohsen, Mahboub Ahari Alireza, Badakhshan Abbas, Gholipour Mahin, Joulaei Hassan
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Iranian Center of Excellence in Healthcare Management, Tabriz University of Medical Sciences, Tabriz, Iran.
Iran J Radiol. 2015 Sep 8;12(4):e18372. doi: 10.5812/iranjradiol.18372v2. eCollection 2015 Oct.
Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study.
The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs).
We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios.
Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs.
As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs.
磁共振成像（MRI）技术在诊断成像领域取得了显著发展，MRI技术成本高昂以及官方收费（费率）存在争议性问题，这些都是开展本研究并将其付诸实施的主要动机。
本研究旨在使用作业成本法（ABC）这一现代成本核算系统来计算MRI服务的单位成本，并将计算得出的单位成本与官方收费（费率）进行公平比较。
我们纳入了设拉子沙希德·法吉希医院2011财年提供的MRI服务的直接成本和间接成本。采用直接分配法分配间接费用。我们使用微观成本核算方法来计算所有不同MRI服务的单位成本。临床成本数据从医院登记系统中获取。采用直线法估算折旧成本。为应对不确定性并提高研究结果的稳健性，在两种情况下计算了33项MRI服务的单位成本。
根据第一种和第二种情况，MRI活动中心（AC）的年度总成本分别计算为400,746美元和532,104美元。总成本的10%分配自支持部门。MRI中心的年度可变成本计算为295,904美元。第一种和第二种情况分别产生的资本成本为104,842美元和236,200美元。超过一半的MRI服务的现行费率高于计算成本。
作为一家公立医院，沙希德·法吉希医院的财务和行政数据库存在相当大的局限性。人工成本在沙希德·法吉希医院年度总成本中占比最大。单位成本与费率之间的差距意味着，向医疗服务提供者索要额外预算的要求可能与所研究的MRI中心提供的所有服务无关。经过一些调整后，ABC可以在MRI中心实施。通过建立诸如ABC技术这样可靠的成本核算系统，医院将能够为其间接、中间和最终活动中心的财务管理提供有力证据。
