Costing the outpatient rehabilitation services in Nezam-Mafi Rehabilitation Center

Objectives: One of the basic challenges of health care centers is the inflated costs of services. Rehabilitation services play a significant role in restoring people's functional ability and returning people with disabilities to society. Costing the rehabilitation services in an accurate way could sustain advisable decisions on activity based budgeting and optimal resource allocation. The objective of this study is to employ Time-Driven Activity Based Costing (TDABC) method to accurately calculate the unit cost of outpatient rehabilitation services at the Nezam-Mafi Rehabilitation Center (NMRC) in 2019, and to use this information to make efficiency-promoting decisions in the center. Materials and Methods: The present study is a descriptive, cross-sectional and retrospective study that used Time-Driven Activity Based Costing (TDABC) method to costing the 9 standard rehabilitation service codes (including speech therapy, occupational therapy, physiotherapy and audiology) provided in the NMRC in 2019. In the first step, the sequence of activities in each code-service was mapped. Then, the resources needed to perform each activity were identified and the cost source for each activity was specified. In the next step, the cost driver for resources and the amount of their use in each activity was determined. Due to the importance of personnel costs, this stage has been calculated with more detail on the time required to provide each activity. To this end, the cost of each minute of human resources calculated by considering the annual practical working time and their salary expenses. Finally, the costs of each unit of the production factor and the total cost for each code-service presented. Results: The cost structure of the NMRC shows that rent (47.9%), consumable materials and supplies (11.6%), and contracted services (10.5%) had the highest share in the costs. The results indicate that the cost of outpatient rehabilitation services at the center (except for speech therapy) was higher than official tariffs for public healthcare providers. The cost of "professional personnel" in physiotherapy services and the "cost of building" in occupational therapy, speech therapy, and audiology services had the highest share in their unit costs. The total cost of staff personnel in the NMRC is estimated at 3,904 Rials per minute (RPM), which was higher than the professional labor cost of pediatric occupational therapy (2.046 RPM), occupational therapy (1.929 RPM), speech therapy (1.899 RPM), and audiology (1.974 RPM) in this center. The high overhead costs of outpatient rehabilitation services can be considered as one of the primary reasons for the gap between the cost and tariffs. On average, overhead costs make up 24.5% of the total costs of these services, which can lead to higher prices for patients and payers. Conclusion: The cost analysis of outpatient rehabilitation services at the NMRC reveals a considerable discrepancy between the cost of its services and tariffs. Due to the low and non-optimal scale of the NMRC, overhead costs have led to the inflation of the cost of services in this center. Therefore, the integration of small institutions and an enhanced referral system for people with disabilities from medical centers can reduce the average cost of services. Considering that most rehabilitation services are not covered by social insurance and are not affordable, a national-level reform should be prepared in the healthcare system. In addition, using the TDABC method in rehabilitation service centers can be a short-term necessity to identify the main sources of costs and control price inflation in the health sector.