Operational costing of inpatient orthopaedic services at the Helen Joseph Hospital

[摘要] BACKGROUND: Until recently budget allocation for public hospitals in theGauteng Province were based on the historical values and not on the costedactivities. It is therefore unknown how much of the allocated budget is usedper discipline in an institution. Because of recurrent over expenditure byinstitutions, Gauteng Department of Health and Social Development havedecided to change policy for budget allocation of funding public healthfacilities from historical allocation to activity based costing. Although goodfinancial management of hospitals is a priority for the government, data onreal costs of providing health care services is scarce and unreliable. No formalstudy has been done to estimate the cost to provide inpatient services in theHelen Joseph Hospital, a regional hospital in the Gauteng Province. In view ofthat, it was decided to initiate this study at the Orthopaedic unit of theHospital, which would then be extended to the other units.AIM: To estimate the caseload, profile of patients and operational cost ofproviding the inpatient orthopaedics services at a regional hospital inGauteng.METHODOLOGY: A cross-sectional study design was used based onretrospective review of patients’ and hospital records of patients admittedduring one month study period at the two Orthopaedic Ward in the HelenJoseph Hospital, situated in the Johannesburg Health District in the GautengProvince.RESULTS: Total number of patients admitted in the Orthopaedic Unit of theHospital in the year 2009/2010 was 2160 (The mean number of inpatients permonth was 180 ± 28).Profile of patientsOne hundred and ninety seven patients were admitted during one monthstudy period. There were more male than female patients. The median agewas 41 years (IQR 31-53 years). More black patients were admitted duringthis period, even though the main catchment population for the Hospital ispredominantly white and coloured. The majority of patients were from a lowsocio-economic class as reflected by their classification for user fee payment using the means test. The median inpatient day was 3. The most commoncause of admissions is due to injury, poisoning and certain otherconsequences of external causes as expected in an Orthopaedic Ward. A lowcomplication rate (4.5%) was found to be the lowest as compared to otherunits in the Hospital. The majority of patients were discharged.Cost driversThe major cost driver was human resource which accounted for 70% of thetotal expenditure. Other cost drivers were material resources used in the unit,which includes: laboratory, blood and blood products, radiology andpharmaceuticals. Expenditure on these items account for only 13.7% of totalexpenditure.Cost driver Amount Unit costLaboratory R61,215.57 R412.26Blood and blood products R53,164.41 R269.87Radiology R52,085.50 R264.39Pharmaceuticals R17,315.82 R87.90The total expenditure during this period was R 1,481,363.30 or R17,776,359.60 annually. The unit cost of laboratory services (Ward 4: R926.30and Ward 5: R272.97), blood and blood products (Ward 4: R463.05 andWard 5: R217.52), radiology (Ward 4: R659.97 and Ward 5: R157.20) andpharmaceuticals (Ward 4: R236.63 and Ward 5: R47.60) and variedsignificantly between Ward 4 and Ward 5 which might be due to difference inclinical practices between the two Wards.CONCLUSION: This study showed the operational costs needed to providean inpatient orthopaedic service at a regional health facility. Further studybased on more detailed costing at individual patient level is necessary todevelop a better understanding of costing at these Wards. This studyhighlighted the significance of understanding the importance of determiningthe actual costs needed to provide an inpatient service in a health facility.Simple cost analysis method could easily be done at Unit/ Ward level toprovide more insight to Hospital managers who are always criticized for overexpenditure.

[发布机构] University of the Witwatersrand