محاسبه بهای تمام‌شده‌ خدمات بخش آزمایشگاه درمانگاه اعلمی هرندی تأمین اجتماعی اصفهان بر اساس روش هزینه‌یابی بر مبنای فعالیت زمان‌گرا و مقایسه آن با تعرفه‌های مصوب در سال 1394

نوع مقاله: مقاله پژوهشی

نویسنده

مربی حسابداری دانشگاه پیام نور تهران.

چکیده

چکیده
مقدمه: بیمارستان‌ها و درمانگاه‌ها با چالش کمبود منابع و افزایش هزینه‌ها مواجه هستند. بنابراین، اطلاعات در مورد هزینه‌ها و بهای تمام‌شده‌ی خدمات سلامت می‌تواند در تخصیص بهینه منابع، شناسایی سطح عملکرد مراکز فعالیت در مصرف منابع، اصلاح بودجه و نرخ تعرفه مؤثر باشد.
روش پژوهش: روش این پژوهش بر اساس هدف، کاربردی-‌توسعه‌ای و از نظر ماهیت، توصیفی-‌پیمایشی است و برای گردآوری داده‌ها و تجزیه‌وتحلیل آن از روش‌های کتابخانه‌ای و میدانی استفاده شده ‌است. در این پژوهش بهای تمام‌شده‌ 51 نوع آزمایش، با استفاده از روش هزینه‌یابی بر مبنای فعالیت زمان‌گرا محاسبه و با تعرفه‌های مصوب سال 1394 مقایسه شد. در پایان تفاوت میانگین بهای تمام‌شده محاسبه شده با میانگین تعرفه‌های مصوب با استفاده از t زوجی آزمون شد.
یافته‌ها: هزینه‌های منتسب به بخش آزمایشگاه بالغ بر 636ر912ر068ر1 ریال محاسبه شد که از این میزان بیشترین سهم، به ترتیب، مربوط به حقوق و مزایای کارکنان (66%)، هزینه‌های مراکز فعالیت پشتیبانی (18%) و هزینه استهلاک تجهیزات آزمایشگاهی (7%) است. بهای تمام‌شده‌ برخی از خدمات ارائه شده در این بخش کم‌تر از تعرفه‌های مصوب و برخی بیشتر بود.
نتیجه‌گیری: نتایج نشان داد که بین بهای تمام‌شده‌ واقعی خدمات و تعرفه‌های مصوب تفاوت وجود دارد. در نتیجه، بهتر است برای قیمت‌گذاری درست‌تر خدمات از روش‌های دقیق محاسبه هزینه‌ها مانند روش هزینه‌یابی بر مبنای فعالیت زمان‌گرا استفاده شود. با توجه به سهم بالای هزینه‌های مربوط به کارکنان و هزینه‌های تخصیص‌یافته از مراکز فعالیت پشتیبانی، توجه ویژه به این منابع، استفاده درست و مناسب از آن، تجدید در ساختار نیروی انسانی، چند تخصصی‌کردن کارکنان، شناسایی و حذف هزینه‌های هدررفت منابع انسانی و تعیین ظرفیت بلااستفاده بخش آزمایشگاه می‌تواند گام‌های مؤثری در جهت افزایش کارایی و صرفه‌جویی در هزینه‌ها باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Calculating the Cost of Services of Laboratory in Alami Herandi Clinic of Isfahan Social Security Organization Using Time-Driven Activity-Based Costing and Comparing It with the Approved Tariffs in 2015

نویسنده [English]

  • Sayyed Amin Alamshah
Instructor, Department of Accounting, Payame Noor University , Tehran, Iran
چکیده [English]

Introduction: Since hospitals and clinics are confronting the challenge of resource shortages and rising costs, the information of the costs of health services can be efficient in optimal resource allocation and identifying the performance of centers active in using resources, budget reform and tariff rates.
Method: This study applies the practical-developmental method and it is descriptive-survey research. The library and field methods were administered to collect and analyze data. The costs of service for 51 types of tests were compared through time-driven activity-based costing and tariffs approved over 2015. Finally, the difference between the mean of cost and the mean of tariff rates was analyzed by paired sample t-test.
Results: The expenses of the laboratory is estimated 1,068, 912, 636 Rials, which the maximum amount is dedicated to staffs’ salaries and benefits (66%), the expenses of logistic centers (18%), and the depreciation expenses of the laboratory equipment (7%).  The cost of some services provided in this department is more and sometimes less than the approved tariffs.
Conclusion: According to the results, there is a difference between the real cost of services and the approved tariffs, thus in order to price the services more accurately, precise methods such as time-driven activity-based costing can be used.  Regarding the high expanses of staff and costs allocated by the logistic centers, taking these resources into consideration significantly as well as spending them properly and effectively, reviewing the structure of human powers, assigning certain tasks to staff, identifying and removing the extra expenses of human powers and determining the unused capacity of the laboratory may raise increase efficiency and avoid unnecessary expenses.

کلیدواژه‌ها [English]

  • Activity-Based Costing
  • cost
  • Time-Driven Activity-Based Costing
  • Laboratory
  • Clinic
  • Social Security Organization
  • Treatment Tariff
1      Abolhallaj, M. (2006). Financial Foundations of Health Organizations, 1st Edition, Tehran: Benfam. [In Persian]

2      Cooper, M. and R. Kaplan (1998). The Design of Cost Management Systems, 2nd Edition, USA: Prentice-Hall Co.

3      Zahedi, M. R. (2005). “Determining the Cost of Health Services According to the Type of Service and the Service Provider Units at the Level of the Health Center of Borujen City”, The Third National Seminar on Health Service Management Students, 14 and 15 May, Tehran. [In Persian]

4      Shepard D. S.; Hodgkin D.; and A. Yvonne (2000). Analysis of Hospital Costs: A Manual for Managers, 1st Edition, Waltham: Brandeis University.

5      Mobaraki, H.; Hadian, M.; Salemi, M.; Alizadeh, A.; and Sh. Mohseni (2012). “Investigating the Cost of Health Services Using Performance-Based Budgetting in Health Center of Roodan City-Hormozgan Province”, Journal of Hormozgan University of Medical Sciences, Vol. 16, No. 1, pp. 34-41. [In Persian]

6      Lievens, Y.; Bogaert, W.; and K.  Kesteloot (2003). “Activity-Based Costing: A Practical Model for Cost Calculation in Radiotherapy”, International Journal of Radiation Oncology Biology Physics, Vol. 57, No. 2, pp. 522-535.

7      Arab, M.; Ghiasvand, H.; Dorroudi, R.; Akbari Sari, A.; Hamidi, M.; and J. Moghri (2012). “Determining the Radiology Services Cost in Selected Hospitals Affiliated with Tehran University of Medical Sciences Using Activity-Based Costing Method in 2010-2011”, Hospital, Vol. 11, No. 3, pp. 27-36. [In Persian]

8      Abdul Majid, J. and M. Sulaiman (2008). “Implementation of Activity Based Costing in Malaysia: A Case Study of Two Companies”, Asian Review of Accounting, Vol. 16, No. 1, pp. 39-55.

9      Yee-Ching Lilian, C. (1993). “Improving Hospital Cost Accounting with Activity-Based Costing”, Health Care Management Review, Vol. 18, No. 1, pp. 71-77.

10  Torabi, A.; Keshavarz, Kh.; Najafpour, Zh.; and E. Mohamadi (2011). “Computing the Cost of Radiology Ward Services of Golestan Hospital of Ahvaz University of Medical Sciences Using Activity-Based Costing Method in 2009”, Hospital, Vol. 10, No. 2, pp. 38-49. [In Persian]

11  Naughton-Travers J. P. (2001). “Activity-Based Costing: The New Management Tool”, Behavioral Health Management, Vol. 21, No. 2, pp. 48-52.

12  Kaplan, R. and S. Anderson (2007). “The Innovation of Time-Driven Activity-Based Costing”, Journal of Cost Management, Vol. 21, No. 2, pp. 5-17.

13  Kaplan, R. and S. Anderson (2007). Time-Driven Activity-Based Costing: A Simpler and More Powerful Path to Higher Profits, 1st Edition, Boston: Harvard Business School Press.

14  Kaplan, R. and S. Anderson (2007). “The Speed-Reading Organization”, Business Finance, Vol. 13, No. 6, pp. 38-41.

15  Bruggeman, W.; Everaert, P.; Sarens, G.; Anderson, S.; and Y. Levant (2008). “Cost Modeling in Logistics Using Time-Driven ABC: Experiences from a Wholesaler”, International Journal of Physical Distribution and Logistics Management, Vol. 38, No. 3, pp. 172-191.

16  Khani, A.; Mehrani, S.; and E. Ghane (2014). “Applying Time-Driven Activity-Based Costing in the ICU Ward of Shariati Hospital of Isfahan Province”, Journal of Health Accounting, Vol. 2, No. 4, pp. 40-57. [In Persian]

17  Beyranvand, R.; Ebadi Fard Azar, F.; Emamgholipour, S.; and M. Arab (2015). “Calculating the Cost of Services of Physiotherapy Ward of Sina Hospital of Tehran University of Medical Sciences Using Activity-Based Costing Method and Comparing that with Approved Tariffs: 2013-2014”, Hospital, Vol. 15, No. 2, pp. 49-58.  [In Persian]

18  Zamandi, M.; Zamandi, H.; Raei, B.; and A. Norozi (2015). “Determining the Cost of Services of Hematology Ward of Imam Reza Hospital Using Activity-Based Costing Method in the First Semiannual of 2014”, Hospital, Vol. 14, No. 4, pp. 83-93. [In Persian]

19  Arab, M.; Yousefvand, M.; and M. Zahavi (2012). “Calculating the Bed-Day Cost and Day-Patient Cost of Men’s Orthopedi Ward of Khomeiny Hospital of Tehran University of Medical Science Using Activity-Based Costing Method in 2008”, Hospital, Vol. 12, No. 1, pp. 29-38. [In Persian]

20  Nasiri-Poor, A. A.; Tabibi, J.; Maleki, M. R.; and T. Nourozi (2010). “Computing the Cost of Clinical Laboratories Services of Tehran Valiasr Hospital Using Activity-Based Costing in 2008”, Hospital, Vol. 8, Nos. 3 and 4, pp. 5-17.  [In Persian]

21  Mohebbi, M. and Gh. Talebnia (2016). “The Comparison of the Cost of Services Provided to Diabetic Patients Using Time-Driven Activity-Based Costing and Traditional Methods in Nader Kazemi Shiraz Health Center”, Journal of Health Accounting, Vol. 5, No. 1, pp. 43-59. [In Persian]

22  Rahiminezhad, A.; Bagherpour, M.; Erjaie, A.; and M. Sepehri (2014). “Developing the Human Resources Costing Method Depending on Time-Driven Activity (A Case Study: Bu-Ali Sina Hospital, the Emergency Ward, Tehran)”, Journal of Health Accounting, Vol. 3, No. 2, pp. 63-76. [In Persian]

23  Jamie, R. and F. Rezaie Yamin (2015). “Calculating the Cost of Health Care Services of Isfahan Social Security Hospital Using Time-Driven Activity-Based Costing Method”, Journal of Health Accounting, Vol. 4, No. 2, pp. 1-21. [In Persian]

24  Yun, B.; Prabhakar, A.; Warsh, J.; Kaplan, R.; Brennan, J.; Dempsey, K.; and A. Raja (2017). “Time-Driven Activity-Based Costing in Emergency Medicine”, Annals of Emergency Medicine, Vol. 67, No. 6, pp. 765-772.

25  Gregório, J.; Russo, G.; and L. Lapão (2016). “Pharmaceutical Services Cost Analysis Using Time-Driven Activity Based Costing: A Contribution to Improve Community Pharmacies’ Management”, Research in Social & Administrative Pharmacy, Vol. 12, No. 3, pp. 475-485.

26  Kaplan, A.; Agarwal, N.; Setlur, N.; Tan, H.;  Niedzwiecki, D.; McLaughlin, N.; Burke, M.; Steinberg, K.; Chamie, K.; and C. Saigal (2015). “Measuring the Cost of Care In Benign Prostatic Hyperplasia Using Time-Driven Activity-Based Costing (TDABC)”, Healthcare, Vol. 3, No. 1, pp. 43-48.

27  Moreno, K. (2007). “Adaptation of Activity-Beads Costing (ABC) to Calculate Unite Costs in Mental Health Care in Spain”, The European Journal of Psychiatry, Vol. 21, No. 2, pp. 117-123.

28  Suthummanon, S.; Omachuno, V.; and M. Akcin (2005). “Applying ABC to the Nuclear Medicine Unit”, Journal of Health Services Management Research. Vol. 18, No. 3, pp. 141-150.

29  Grandlich, C. (2004). “Using Activity-Based Costing in Surgery”, Journal of AORN, Vol. 79, No. 1, pp. 189-192.

30  Yangyang, R.; Paulette, I.; Carolyn, M.; Kathleen, E.; Hui, R.; Binita, P.; Jed, G.; and E. Monica (2017). “Time-Driven Activity-Based Costing: A Dynamic Value Assessment Model in Pediatric Appendicitis”, Journal of Pediatric Surgery, Vol. 52, No. 6, pp. 1045-1049.

31  Lievens, Y.; Van Den Bogaert, W.; and K. Kesteloot (2003). “Activity-Based Costing: A Practical Model for Cost Calculation in Radiotherapy”, International Journal of Radiation Oncology Biology Physics, Vol. 57, No. 2, pp. 522-535.

32  Negrini, D.; Kettle, A.; Sheppard, L.; Mills G.; and D. Edbrooke (2004). “The Cost of a Hospital Ward in Europe: Is there a Methodology Available to Accurately Measure the Costs?”, Journal of Health Organization and Management, Vol. 18, No. 3, pp. 195-206.

33  Nikpajouh, A.; Shariati, B.; and S. Soheili (2009). “Calculating the Unit Cost of Services of the Radiology Ward of Amir Alam Hospital Using Step-Down Method”, Payesh, Vol. 8, No. 3, pp. 235-244. [In Persian]

34  Tibesku, C.; Hofer, P.; Portegies, W.; Ruys, C.; and P. Fennema (2013). “Benefits of Using Customized Instrumentation in Total Knee Arthroplasty: Results from an Activity-Based Costing Model”, Archives of Orthopaedic and Trauma Surgery, Vol. 133, No. 3, pp. 405-411.

35  Antikain, K.; Roivainen, T.; Hyvärinen, M.; Toivonen, J.; Kärri, T.; and M. Sc (2005). “Activity-Based Costing Process of a Day-Surgery Unit-From Cost Accounting to Comprehensive Management”, Journal of Frontiers of E-business Reaserch, Vol. 1, No. 1, pp. 1-15.