۱- Introduction

۲- Theoretical framework and research background

۳- Fuzzy Logic-Time Driven Activity-based costing model (FL-TDABC)

۴- A numerical example, results, and discussion

۵- Conclusion and recommendations

References

Abstract

Hospital traditional cost accounting systems have inherent limitations that restrict their usefulness for measuring the exact cost of healthcare services. In this regard, new approaches such as Time Driven-Activity based Costing (TDABC) provide appropriate information on the activities needed to provide a quality service. However, TDABC is not flawless. This system is designed for conditions of relatively accurate information that can accurately estimate the cost of services provided to patients. In this study, the fuzzy logic in the TDABC model is used to resolve the inherent ambiguity and uncertainty and determine the best possible values for cost, capacity, and time parameters to provide accurate information on the costs of the healthcare services. This approach has not yet been tested and used in determining the costs of services of a healthcare setting. Therefore, the aim of this study is to present a new Fuzzy Logic-TDABC (FL-TDABC) model for estimating healthcare service costs based on uncertainty conditions in hospitals. The proposed model is implemented in a sample of the hospital laboratory section and the results are compared with the TDABC system. The TDABC model, by allocating the activity costs including fixed costs and not considering the uncertainty regarding the cost, capacity, and time required for each patient, often estimates the unused capacity and costs with a higher margin of error. The results show that the maximum difference in the prescribed costs was 4.75%, 3.72%, and 2.85% in blood bank, microbiology, and hematology tests, respectively, mostly due to uncertainty in the costs of consumables, equipment and manpower (on average 4.54%, 3.8%, and 3.59%, respectively). Also, The TDABC system, in comparison with the proposed system, estimates the unused capacity of the resource with more error. Cost of unused capacity derived using FL-TDABC were 80% of costs derived using TDABC. In conditions where the information is ambiguous, using the new system in hospitals can lead to a more accurate estimate of the cost compared to the TDABC system. Moreover, it helps hospital managers to make appropriate decisions about the use of capacity, capital budgeting, cost control, and etc.

Introduction

Hospitals and healthcare centers as major operating units of the healthcare sector play an important role in promoting public health. One of the important factors in the continued service of this sector is how to manage resources and control costs. Balancing costs with generated revenues is one of the main challenges of many hospitals in the country. In most hospitals in the country, costing and determining the cost of services are directed via traditional costing systems (TCSs) based on reimbursement, which does not provide information on the exact amount of healthcare costs. Due to the prime focus of these systems on reimbursement, less attention has been paid to understanding the exact amount of true healthcare costs and implementing strategies to reduce them. A costing approach that can provide true cost of patient care services would enable hospitals to manage resources, improve the efficiency of processes, adapt medical skills to processes, increase patient satisfaction, and ultimately reduce the costs. The lack of such knowledge will lead to the lack of understanding the link between costs and process improvements. Moreover, it could be an obstacle to reduce costs in hospitals and healthcare centers, leading to higher healthcare costs. Therefore, designing and implementing a system that provides suitable decision-making grounds for managers to better manage resources in order to reduce the cost of healthcare is of high necessity.