This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research article
Kathia Dubron
Katholieke Universiteit Leuven Faculteit Economie en Bedrijfswetenschappen
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1275-2771
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is to demonstrate how the overall cost of childbirth at the maternity department can be calculated by implementing a TDABC analysis. In addition, this study outlines how this costing method can be utilized to provide insights into how patient and disease characteristics drive variability within childbirth cost. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost.
Methods Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly.
Results Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+33,3 min) and monitoring (+775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age >25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks.
Conclusions TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.
Keywords
Obstetrics, time-driven activity-based costing, vaginal birth, caesarean section, health management
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
- Supplementaryfile1.docx
- Supplementary file 1 o English survey
- Supplementaryfile2.docx
- Supplementary file 2 o Dutch survey (original version) - Description: The survey was practically designed to collect information easily and smoothly and administered orally in the native language of the participants, by the staff and nurses. Time recordings were done by the same person who did the survey. All surveys were collected anonymously by the main researchers.
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Subject Areas
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This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Kathia Dubron
Katholieke Universiteit Leuven Faculteit Economie en Bedrijfswetenschappen
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1275-2771
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 18 Mar, 2021
No community comments so far
Reviewer #2 agreed
On 28 Mar, 2021
Review #1 received
Received 12 Mar, 2021
Reviewer #1 agreed
On 27 Feb, 2021
Editor assigned
On 24 Feb, 2021
Reviewers invited
Invitations sent on 24 Feb, 2021
Submission checks complete
On 24 Feb, 2021
Editor invited
On 24 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is to demonstrate how the overall cost of childbirth at the maternity department can be calculated by implementing a TDABC analysis. In addition, this study outlines how this costing method can be utilized to provide insights into how patient and disease characteristics drive variability within childbirth cost. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost.
Methods Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly.
Results Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+33,3 min) and monitoring (+775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age >25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks.
Conclusions TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.
Figure 1
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