Activity-Based Costing of Hemodialysis Services, Transplant and Dialysis Unit, Maharaj Nakorn Chiang Mai Hospital
Keywords:
Activity-Based Costing, Dialysis Unit, HemodialysisAbstract
Activity-based costing (ABC) provides hospitals with a systematic method for accurate budgeting and resource allocation, especially for complex medical services such as hemodialysis. This study applied ABC to evaluate the unit costs of three key procedures central venous catheter insertion, conventional hemodialysis, and online hemodiafiltration (OHDF) at the Kidney and Dialysis Unit, Maharaj Nakorn Chiang Mai Hospital, and compared these costs with reimbursement rates provided by the National Health Security Office (NHSO), Social Security Office (SSO), and Comptroller General's Department (CGD). A time-study method determined the sample size, while data collection employed three research instruments: a hemodialysis dictionary, time recording form, and cost recording form. Content validity was affirmed by three experts, and inter-rater reliability yielded a coefficient value of 1.00. Descriptive statistics were used for data analysis.
The results showed that the unit cost of central venous catheter insertion was 1,688.94 baht, significantly exceeding the reimbursement rate of 488.94 baht from all public funders. The unit cost for conventional hemodialysis was 2,540.09 baht, which was higher than the NHSO and SSO rate of 1,040.90 baht, and surpassed the CGD rate by 540.09 baht. For OHDF, the cost was 3,226.50 baht, outpacing the NHSO and SSO rate by 1,500 baht, and the CGD rate by 1,226.50 baht. These findings highlight a substantial gap between actual service costs and the current reimbursement structure, posing a risk to the sustainability of hemodialysis services.
This study recommends that hospital administrators implement effective cost control measures and utilize these findings to support negotiations aimed at increasing reimbursement rates from relevant government agencies. Such actions are crucial for ensuring the long-term financial viability of hemodialysis services and maintaining quality patient care.
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