PRM38 - Indirect Costs Calculation Method In Medium-Sized Regional Hospital

Abstract

The objective was to suggest a solution to indirect costs calculation in outpatient and inpatient care to be used in HTA studies. Model scenarios were computed based on real operational data from a medium-sized regional hospital. Several cost allocation methods were used. Results were statistically analysed and compared. For the purpose of indirect cost value determination, methods are suggested taking account of (i) number of inpatient days, (ii) rate per hour, and (iii) marginal mark-up allocation. (The considered method of weighted service allocation was eliminated due to incomplete economic and medical data and its complexity in terms of time and demands on staff collaboration). All methods were applied to the diagnosis of essential hypertension, cerebral infarction, colorectal cancer and hip joint arthrosis. Resulting indirect costs (expressed as a percentage of total costs) were significantly different for individual diagnoses, and these differences were significantly influenced also by the particular therapeutic intervention and the choice of cost allocation method. The method based on the inpatient day calculation leads to an underestimation of indirect costs of hospital services for short-term hospitalizations. The allocation method based on the rate per hour is insufficient for assessing indirect costs of long-term hospitalizations. The problem with marginal mark-up allocation is a difficult quantification of direct costs of the diagnosis and intervention. There is a need for a thorough analysis of the input data that were poorly accessible and very poorly recorded in our case. Generally, the inpatient day method should be used to support budgetary decisions, where the average price for one day of hospitalization is important. The method based on the rate per hour is useful in determining indirect costs for an individual patient. The marginal mark-up method may not be precise enough, but can be used for comparisons with other methods.