Activity-based costing in health institutions: Application in public hospital intensive care ünit

In this research, the cost of a patient hospitalized in the 1st Step Intensive Care (ICU) Service of a public hospital to the healthcare institution was determined using the activity-based costing (ABC) method. The cost per patient obtained as a result of the research is evaluated by comparing the reimbursement made according to the Social Security Institution Health Practice Communiqué tariff and the cost calculated using the ABC method. In the research, studies were first conducted to evaluate the applicability of the ABC method and it was aimed to present this method as an easy and understandable model. In this context, the study group of the research consists of patients who were treated in the 1st Step ICU service in 2019. Since the study group of the study was large, it was decided to randomly select 60 patients. According to the results of the research, 67% of the expenses incurred for the patients in the study group are personnel expenses, 18% are general production expenses, and 15% are raw materials and laboratory and radiology outsourcing costs. The total cost of general production expenses, raw material and materials, laboratory and radiology outsourcing costs, and personnel expenses for the 60 patients in the study group was determined as ₺97,221.61. When the ABC method results are compared with the total Social Security Institution reimbursement amount, Social Security Institution paid ₺48,141.32 to the healthcare institution for these patients, which corresponds to 49.5% of the total cost. The difference between the cost incurred by the health institution and the reimbursement of Social Security Institution was determined as ₺49,080.44, which corresponds to 50.5% of the total cost. It is seen that the costs calculated separately for 60 patients with the ABC method are higher than the Social Security Institution reimbursement amounts. It is considered that the differences between the reimbursement and ABC method are that the payment made per day of hospitalization, excluding the first hospitalization and discharge day, and the amount of payments made per service according to the Health Practice Communiqué tariff are insufficient. Health institutions should reduce costs by making training programs and technological investments that will increase staff efficiency, and solutions such as electronic health record systems and automatic drug distribution systems. In addition, efficiency can be increased and costs can be reduced by accelerating patient admission processes, clarifying job descriptions, and applying data-based management decisions to optimize workflows and increase bed occupancy rates. Academic studies should evaluate the applicability and effectiveness of the ABC method in the healthcare sector through comprehensive and multi-center research, and also develop systems that make cost prediction and optimization using artificial intelligence and big data analytics. Innovative approaches such as flexible working hours, telehealth applications and hybrid business models should be investigated and their feasibility tested to reduce personnel costs. Keywords: Activity Based Costing, Intensive Care Service, Cost per Patient, Cost Analysis