KU Leuven, University Hospital Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
KU Leuven, Faculty of Economics and Business, Research Centre Accountancy, Leuven, Belgium.
BMC Pregnancy Childbirth. 2021 Oct 20;21(1):705. doi: 10.1186/s12884-021-04134-4.
Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is the application of a time-driven activity-based method in order to estimate the cost of childbirth at a maternal department. Moreover, this study shows how this costing method can be used to outline how childbirth costs vary according to considered patient and disease characteristics. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost.
A prospective cohort study design is performed in a maternity department. Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly.
Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+ 33,3 min) and monitoring (+ 775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age > 25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks.
TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.
最近，时间驱动作业成本法（TDABC）被提出作为一种替代方法，更准确地计算医疗治疗的成本，因为它允许将成本直接分配给患者。本文的目的是应用时间驱动作业成本法来估计妇产科分娩的成本。此外，本研究展示了如何使用这种成本核算方法来概述分娩成本如何根据所考虑的患者和疾病特征而变化。通过使用流程映射，TDABC 可以准确地确定哪些活动和相应的资源受到这些特征的影响，从而更深入地了解分娩成本。
在妇产科进行前瞻性队列研究设计。为两种分娩方式（阴道分娩（VD）和剖宫产（CS））开发了流程图。成本从财务部门获得，并相应计算产能成本率。
总体而言，分娩的成本为 1894.12 欧元，主要由人员成本（89.0%）驱动。产后监测是路径上最昂贵的活动，成本为 1149.70 欧元。发现不同分娩类型之间存在显著的成本差异，VD 的成本为 1808.66 欧元，而 CS 的成本为 2463.98 欧元。CS 中延长的临床访视（+33.3 分钟）和监测（+775.2 分钟）是导致这种成本差异的主要原因。在每种分娩方式中，年龄、产次、妊娠周数和教育程度都被发现是导致成本变化的因素。特别是对于 VD，年龄>25 岁、初产妇、妊娠周数>40 周和较高的教育程度与较高的成本相关。在 CS 中也发现了类似的结果，年龄、产次和妊娠周数与成本相关。
TDABC 是一种有价值的方法，可以衡量和理解整个护理周期内分娩成本及其相关驱动因素的变化。因此，这些发现可以为医疗保健提供者、管理人员和监管机构提供有关流程改进和成本控制措施的信息。
