Table 3
Cost per minute per year (D /min).
Gastroenterology Dermatology Nose-Throat and Ears Plastic Surgery Urology
Secretary costs 0.6892 0.5708 0.4594 0.4541 0.6303
Machine costs 0.0426 0.0193 0.0781
Costs for medical materials 0.1834 0.0221 0.0228 0.0198 0.1200
Costs for cabinets 0.1320 0.0972 0.0869 0.0444 0.1112
Costs for operating rooms 0.1320
Nurses labour costs 0.5968
account for the calculations, which leads to a cost of
0.0420D /min for the Gastroenterology department. The
cost per minute for the usage of medical materials at the Gastroenterology
department is 0.0583D /min for the technical
medical materials and of 0.1834D /min for the non-technical
medical materials. Next, in order to attain the cost per
minute for the usage of the cabinets, we divide the costs
of the cabinets by the total number of practical consultation
minutes (136,800min) and end up with a cost of
0.1320D /min. The same cost per minute is used for the extra
operating room (0.1320D /min). The nurses labour cost per
minute for Gastroenterology is calculated by dividing the
total nurses labour cost by the 182,400 practical working
minutes (theoretical capacity amounts 228,000 min) and
results in a cost of 0.5968D /min.
As can be noticed, across the five departments, the
biggest difference in the cost per minute is situated on the
level of the machine costs. This difference is attributable
to the different functionalities and the different pattern of
usage of the machinery across departments.Comparing the
labour secretary costs per minute,we also see a higher cost
at the Gastroenterology department, which is explained by
the higher seniority of the secretaries. The relative high cost
per minute of the non-technical medical materials by Urology
is explained by the higher purchasing cost of this type
of medical materials.
3.2.3. Calculating the cost per patient
In a third step,we calculate the specific cost per patient.
Based on Tables 2 and 3, we are able to calculate the cost
of the activities for a non-technical and a technical consultation
(Tables 4 and 5). These technical and non-technical
cost tables contain standard and optional activities which
are allocated to the patients depending on the treatment
and services they receive. Consultation costs are split into
the cost per activity and the time per activity. Based on the
informationwe gathered, the different time equationswere
filled in.
The costs of standard non-technical consultations can
be found in Table 4. As can be seen, the cost for a standard
non-technical consultation fluctuates between 5.19D
(Plastic Surgery) and 13.78D (Urology).3 While the standard
activities are similar between the departments, this is not
the case for the time rates per activity, nor the nature of the
costs. Bymaking use of linear combinations, we are able to
3 The total cost for Plastic Surgery, for example, is found by the sum of
0.74D formaking an appointment; 1.02D for receiving the patient; 2.78D
for the consultation and 0.64D for the classification of the files. A similar
way of working is followed for the other departments.
make a distinction between different types of patients. For
example, we see that a patient that makes maximal use of
the Plastic Surgery activities costs 8.09D , which reflects an
increase in the standard cost for making an appointment
at the window, receiving laboratory results, an additional
consultation at another department and asking additional
information by phone or at the window. For Gastroenterology,
the maximum cost amounts to 67.58D .
In Table 5 we report the results for technical consultations.
The cost for a technical consultation equals 4.50D
for Dermatology, 7.06D for Plastic Surgery and 51.41D for
Gastroenterology. The costs for a technical consultation
are with exception for the Dermatological department
higher than for a non-technical consultation (i.e. 6.92D for
Dermatology, 5.19D for Plastic Surgery and 13.22D for Gastroenterology).
This exception is explained by the fact that
a technical Dermatological consultation mainly consists of
linking the patient with the PUVA machine for a predetermined
time. As a result, the consultation will pass by
without the intervention of a nurse or physician, which
leads to a lower cost per consultation. For the non-technical
Plastic Surgery consultation the physician needs to have
an in-depth discussion with the patient about his or her
personal motivation for Plastic Surgery. This in-depth discussion
(non-technical) will take more time as a treatment
after surgery (technical).
4. The benefits of TDABC: some management
implications
The TDABC systemprovided accurate and relevant information
to both healthcare managers and physicians which
assisted them in operational improvements (Section 4.1),
making a profitability analysis per department (Section
4.2), deciding on future investments (Section 4.3).
4.1. Operational improvements
The TDABC approach, with its time equations, offers
some specific advantages, as these equations create more
cost transparency than a conventional cost-accounting
system or a traditional ABC system. As the time equations
clearly show which activities demand more time,
healthcare managers may get an idea of which activities
lead to higher costs. Consequently, a TDABC model offers
operational insights concerning activities and their added
value. This way, the outpatient clinic’s management could
take appropriate actions to lower the time required to
handle some actions, especially in the more demanding
departments like Gastroenterology and Urology. An
internal benchmark exercise (which became possible