Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Activity Based Costing in Health Institutions: An Application in Gynecology Clinic of a Public Hospital
Sağlık Kurumlarında Faaliyet Tabanlı Maliyetleme: Kamu Hastanesi Jinekoloji Kliniğinde Bir Uygulama
Mehpare KARAHAN GÖKMENa, Birgül YABANA KİREMİTb, Elif DİKMETAŞ YARDANb
aOndokuz Mayıs University Faculty of Economics and Administrative, Department of International Trade and Logistics Sciences, Samsun, TURKEY
bOndokuz Mayıs University Faculty of Health Sciences, Department of Health Management, Samsun, TURKEY
Turkiye Klinikleri J Health Sci. 2020;5(1):112-21
doi: 10.5336/healthsci.2019-66441
Article Language: EN
Full Text
ABSTRACT
 Objective: The aim of the study is to calculate the unit cost of normal labor and cesarean section using Activity Based Costing (ABC) method that is one of the contemporary methods that provide accurate cost allocations for clinical procedures. Material and Methods: Financial accounting and other data are obtained from a public hospital operating in Samsun for the year of 2014. In the study unit costs for normal labor and cesarean section are analyzed using ABC method. Unit costs that are calculated for normal labor and cesarean section are compared with billed amount. Results: Unit costs for normal labor and cesarean section are calculated according to ABC methods and results are as follows; unit costs for normal labor and cesarean section are correspondingly 814.66 TL(Turkish Liras) and 1.274.21 TL. Finally cost figures for normal and cesarean labors are compared with billed amounts to patients. According to data obtained from hospital the billed amount for normal labor is 539 TL which is below the cost calculated (814.66 TL) in the study. The difference is more dramatic for cesarean labor. The billed amount 618 TL is far below the cost figure calculated in the study which is 1.271.21 TL. Lastly normal labor and cesarean section unit costs that are calculated according to ABC method are compared with price lists in Communique on Healthcare Practices (Sağlık Uygulamaları Tebliği-SUT [HIN]) Conclusion: According to this study, it is determined that there are differences between the unit costs calculated by ABC method of normal and cesarean deliveries and repayment amounts. It is concluded that hospital is incurring losses due to underpricing of normal and cesarean labor operations below their calculated costs. Use of the ABC method in the calculation of the costs of clinical procedures will enable health institutions managers to make more accurate financial planning and financial desicions. In addition, it will increase competitiveness through higher quality service provided to patients.

Keywords: Hospital costs; parturition; cesarean section
ÖZET
 Amaç: Çalışmanın amacı; klinik işlem maliyetlerinin daha gerçekçi hesaplanabilmesine olanak sağlayan çağdaş maliyetleme tekniklerinden Faaliyet Tabanlı Maliyetleme (FTM) yöntemi ile sezeryan ve normal doğum birim maliyetlerinin tespit edilmesidir. Gereç ve Yöntemler: Samsun'da faaliyette bulunan bir kamu hastanesine ait 2014 yılı finansal ve diğer veriler alınmıştır. Çalışmada, normal ve sezeryan doğuma ait birim maliyetler FTM yöntemi ile analiz edilmiştir. Normal ve sezeryan doğum için hesaplanan birim maliyetler hastalara fatura edilen tutarlarla karşılaştırılmıştır. Bulgular: Normal ve sezaryen doğuma ait birim maliyetler FTM yöntemine göre hesaplanmış olup; normal doğum birim maliyetinin 814,66 TL (Türk Lirası) ve sezaryen doğum birim maliyetinin 1,274,21 TL olduğu bulunmuştur. Son olarak normal ve sezeryan doğum için maliyet tutarları hastalara fatura edilen tutarlarla karşılaştırılmıştır. Hastaneden elde edilen verilere göre normal doğum için fatura edilen tutar, hesaplanan maliyetin (814,66 TL) altında olup 539 TL'dir. Sezaryen doğumda fark daha belirgindir. 618 TL sezeryan doğum fatura tutarı, yapılan çalışmada 1,271,21 TL olarak hesaplanan tutarın oldukça altındadır. Son olarak FTM ile hesaplanan normal ve sezeryan doğum birim maliyetleri Sağlık Uygulama Tebliği (SUT) fiyat listesi ile karşılaştırılmıştır. Sonuç: Gerçekleştirilen bu çalışmaya göre, normal ve sezeryan doğumların FTM yöntemiyle hesaplanan birim maliyetleri ile geri ödeme tutarları arasında farklılıkların olduğu tespit edilmiştir. Normal ve sezeryan doğuma ait fatura tutarlarının hesaplanan maliyetten daha az olması hastanenin zarara uğramasına sebep olduğu söylenilebilir. Klinik işlemlerin maliyetlerinin hesaplanmasında FTM yönteminin kullanılması, sağlık kurumları yöneticilerinin daha doğru bir finansal planlama yapabilmesi ve finansal karar verebilmesinde etkili olacaktır. Ayrıca, daha kaliteli hizmet sağlayarak rekabet gücünün arttırılabilmesine olanak sağlayacaktır.

Anahtar Kelimeler: Hastane maliyetleri; normal doğum; sezeryan doğum
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