Sampan'asa Loterana Momba Ny Fahasalamana (SALFA) network, Ampandrozonana, 208, Sambava, Madagascar.
Centre Hospitalier Universitaire (CHU) Toamasina - Service d'Ophtalmologie, 501, Toamasina, Madagascar.
BMC Health Serv Res. 2020 Mar 12;20(1):205. doi: 10.1186/s12913-020-05074-z.
In the absence of adequate and reliable external funding, eye care programs in developing countries need a high level of financial self-sustainability for maintenance and growth. To cope with these cost pressures, an eye care program in Sava, Madagascar adopted a Time-Driven Activity Based Costing (TDABC) methodology to better manage the cost of, and to improve revenue associated with, their three principle activities: consultation visits, cataract operations, and sale of glasses.
Direct (variable) and indirect (fixed) cost estimates and revenue sources were gathered by activity (consultation, cataract operation, sale of glasses) and location (hospital or outreach) and TDABC models were established. Estimates were made of the proportion of the ophthalmologist's time (by far the scarcest and most expensive resource) dedicated to consultation, cataract operation, or sale of glasses. These proportions were used to attribute costs by activity. The hospital manager and medical director modified staff roles, program activities, and infrastructure investments to reduce costs and expand revenue sources by activity while monitoring activity specific efficiency and profit.
The TDABC model for patient consultations showed that they were time consuming for the ophthalmologist and only resulted in net profit for the institution if the ophthalmologist converted most cataract patients into accepting surgery and refractive error patients into purchasing glasses from the hospital optical shop. The TDABC model for cataract surgery showed the programs needed to reduce the cost of imported consumable surgical products, reduce operation time, and, most importantly, reduce the number of very costly surgical camps providing essentially free surgery. In addition the model pushed the hospital to train staff in marketing skills so that a higher proportion of cataract cases come directly to the hospital willing to pay for surgery. The TDABC model provided the optical shop manager, for the first time, data on both the cost of supplies (frames and lenses) and the price of glasses sold resulting in strategies to maximize profit through preferential product presentation and customer experience. The eye program in the Sava region in northern Madagascar improved its cost recovery from 68 to 102% through patient revenue.
TDABC models helped the Sava eye care program develop more efficient service delivery and increase revenue in excess of steadily increasing costs.
在缺乏充足和可靠外部资金的情况下，发展中国家的眼科保健计划需要高度的财务自给自足，以维持和发展。为了应对这些成本压力，马达加斯加萨瓦的一个眼科保健计划采用了时间驱动作业成本法（TDABC）方法，以更好地管理其三项主要活动（就诊、白内障手术和眼镜销售）的成本，并提高与这些活动相关的收入。
通过活动（就诊、白内障手术、眼镜销售）和地点（医院或外展）收集直接（可变）和间接（固定）成本估算和收入来源，并建立 TDABC 模型。估计眼科医生的时间（到目前为止最稀缺和最昂贵的资源）专门用于就诊、白内障手术或眼镜销售的比例。这些比例用于按活动分配成本。医院经理和医疗主任修改了员工角色、项目活动和基础设施投资，以通过活动降低成本并扩大收入来源，同时监测特定活动的效率和利润。
患者就诊的 TDABC 模型表明，就诊对眼科医生来说很耗时，只有当眼科医生将大多数白内障患者转化为接受手术，以及将屈光不正患者转化为从医院配镜部购买眼镜时，医院才会获得净收益。白内障手术的 TDABC 模型表明，该计划需要降低进口耗材手术产品的成本，缩短手术时间，最重要的是，减少提供基本上免费手术的非常昂贵的手术营地的数量。此外，该模型推动医院培训员工的营销技能，以便更高比例的白内障病例直接到医院就诊并愿意支付手术费用。TDABC 模型首次为配镜部经理提供了供应品（镜架和镜片）成本和销售眼镜价格的数据，从而通过优先展示产品和客户体验来制定最大化利润的策略。马达加斯加北部萨瓦地区的眼科计划通过患者收入将成本回收提高了 34%，从 68%提高到 102%。
TDABC 模型帮助萨瓦眼科保健计划提高了服务提供效率，并增加了超过不断增加的成本的收入。
