การศึกษาต้นทุนต่อหน่วยบริการของโรงพยาบาลเกาะลันตาด้วยวิธีวิเคราะห์ ต้นทุนแบบอิงกิจกรรม

Abstract

The objective of this study was to analyse the unit cost of Ko Lanta Hospital, Ko Lanta District, Krabi. Descriptive study was employed using utilization data during the fiscal year 2017 (1 October 2016 - 30 September 2017). There were 3 major parts of study process: 1) analyzed and classified activities for each health care service 2) determined category of cost consumed by each activity and 3) calculated cost of services and unit cost, respectively Result: the top three services accounted for the highest unit cost were inpatient services (2,176 baht/hospital bed day), followed by outpatient services during (717 baht/visit; 704 baht/visit for overtime service) and health promotion and prevention services (404 baht/head), respectively. Matemity service accounted for the highest unit cost among inpatient service (5,597.23 baht/hospital bed day). Referral service was highest unit cost service among outpatient services (2,277.39 baht/visit; 5,941.78 baht/visit for overtime service). The highest unit cost service among promotion and prevention services was communicable disease control service (847.96 baht/head) The activities of pharmacy service and laboratory test accounted for the biggest proportion of service cost. Medicine cost and laboratory supplies were the biggest cost for those high cost activities respectively. When considering by cost category, it was found that the labor cost accounted for the biggest proportion (64.10% of the total cost), followed by material cost (23.05%) and the allocation cost (12.85%) respectively. Salaries/wages took the biggest proportion of labor cost (59.92%) The study found only 3 profitable (income over cost) services. Those were Thai traditional medicine services, physical therapy and rehabilitation services and the dental service (only for the group of patients who pay by themselves). Conclusion: there were 2 major policy recommendations from the study finding 1) Reducing expenditure, especially labor costs, the hospital should optimize the management system of overtime working and also the measures to ensure rational use of medicines and laboratory supplies. 2) Increasing revenue by promoting patient access to those profitable services: traditional Thai medicine services, dental services, and physical therapy and rehabilitation services.