Hospital Costing Process

To achieve this objective, the study has specific objectives, including understanding the cost of services at the current level of service, providing hospital management with data to assess efficiency, and providing the Ministry of Health (MOH) with data to make evidence-based arguments to the Ministry of Finance (MOF) for resources. The methodology employed in this analysis involves top-down costing, where all resources used in the General Hospital are allocated to specific services rendered. A sample of patient records is also used to determine costs for five diseases. Additionally, an assessment of stock-outs in the pharmacy and laboratory is conducted. The General Hospital is organized into various cost centers, including administrative, intermediate, and final cost centers. The administrative cost centers include building maintenance, bioengineer/transport/security/switchboard, and domestics. The intermediate cost centers include laundry, nutritionist, kitchen, pharmacy, laboratory, digital imaging, operating room, ICU/CCU, and physiotherapy. The final cost centers include outpatient general, accident and emergency, NIDCU, eye clinic, inpatient obstetrics and neonatal, male medical, female medical, male surgical, female surgical, gynecology, eye ward, pediatrics, and private ward. The main outcome measures of this analysis include cost per patient bed-day (inpatient care), cost per admission (inpatient care), cost per visit (outpatient clinics), and cost per test, image, service, etc. for intermediate cost centers. The data sources used in this analysis include budget and actual expenditure, inventory of fixed assets and stored materials, tracking of expenditure to final user, hospital departments, direct costs, indirect/shared costs, outputs, number of patients treated, number of services delivered, and revenue generated by departments and key hospital services. The preliminary results of the analysis show that the General Hospital's expenditure is EC$33,988,323, which accounts for 100% of the total costs. The largest expenditure is on salaries and wages, accounting for 73.2% of the total costs. Other significant expenditures include pharmaceuticals, utilities, food services, oxygen, contracted security services, and heavy equipment rental. The unit costs by final cost center show that the cost per outpatient visit for the outpatient general department is EC$169, while the cost per patient admission for the accident and emergency department is EC$134. The cost per patient day for the inpatient obstetrics and neonatal department is EC$644, while the cost per hospital bed is EC$166,675. These preliminary results provide valuable information for hospital management, the MOH, and the MOF to make informed decisions about resource allocation and healthcare policy.