Presently there is a gross lack of information on cost and cost weights in many developing countries that implement
casemix system. Furthermore, studies that employed Activity Based Costing method (ABC) to estimate the costs of radiology
procedures were rarely done in developing countries, including Malaysia. The main objective of this study is to determine
the costs of radiology procedures for each group in casemix system, in order to develop cost weights to be used in the
implementation of the casemix system. An economic evaluation study was conducted in all units in the Department of
Radiology in the first teaching hospital using the casemix system in Malaysia. From the 25,754 cases, 16,173 (62.8%)
of them were from medical discipline. Low One Third and High One Third (L3H3) method was employed to trim the
outlier cases. Output from the trimming, 15,387 cases were included in the study. The results revealed that the total
inpatients’ charges of all the radiology procedures was RM1,820,533.00 while the cost imputed using ABC method was
RM2,970,505.54. The biggest cost component were human resources in Radiology Unit (Mobile) (57.5%), consumables
(78.5%) of Endovascular Interventional Radiology (EIR) Unit, equipment (81.4%) of Magnetic Resonance Imaging (MRI)
Unit, reagents (68.1%) of Medical Nuclear Unit. The one highest radiology cost weight, was for Malaysia Diagnosis
Related Group (MY-DRG®)B-4-11-II (Hepatobiliary and Pancreas Neoplasms with severity level II, 2.8301). The method
of calculation of the cost of procedures need to be revised by the hospital as findings from this study showed that the cost
imposed to patient is lower than the actual cost.
The Malaysia Diagnosis Related Group (MY-DRG®), established since 2002, is a patient classification system that stratifies disease severity and categories patients into iso-resource groups. Casemix can be used to estimate costs per episode of care and as a provider payment tool in health services. Casemix has also been used to enhance quality and improve the efficiency of health services. Hence, estimation cost per DRG is important especially in developing countries where costing data are still scarce. We embarked on a study to determine the costs of the diagnostics laboratory services for each MY-DRG® based on the severity of illnesses. Most costing studies for diagnostic laboratory services usually focus on the cost of consumables and equipment alone and employed the step-down costing method. Very few studies applied Activity-Based Costing (ABC) method to estimate the costs for diagnostic laboratory services. This study was done with the purpose of developing the diagnostics laboratory cost using the ABC method. All medical cases discharged from UKM Medical Centre (UKMMC) in 2011 grouped into MY-DRG® were included in this study. In 2011, a total of 2.7 million diagnostic laboratory investigations were carried out in the Department of Diagnostic Laboratory Services in UKMMC. ABC was conducted from January to December 2013 in all units of the department. Cost of 242 types of diagnostic laboratory services were collected using a costing format. Out of 25,754 cases, 16,173 (62.8%) cases were from the medical discipline. After trimming using L3H3 method, 15,387 cases were included in the study. Most of the cases were on severity level one (44.6%), followed by severity level two (32.3%) and severity level three (23.1%). The highest diagnostic laboratory service weight was for Lymphoma & Chronic Leukemia, severity level III (C-4-11-III) with the value of 5.9609. Information on seven cost components was collected form each procedure: human resources, consumables, equipment, reagents, administration, maintenance and utilities. The results revealed that, the biggest cost component for human resources was in Molecular Genetic Unit (89.6%), consumables (34.8%) from Tissue Culture Unit, equipment (11.2%) and reagents (68.1%) from Specialized Haemostasis Unit. In conclusion, the accurate and reliable cost of the diagnostic laboratory services can be determined using ABC. Top management of the department should be able to use the output of the study to take appropriate steps to reduce unnecessary wastages of resources in the various units of the services.
Clinical coding creates a rich database that can be used for administrative functions including planning for health service programmes and preparing budget of hospitals with appropriate use of disease and procedure classification system. Clinical coding errors may occur in the diagnoses or procedure codes. The errors can be happen at any of the digits use in the classification codes. Errors in clinical coding can give a huge implication on hospital’s income if the coding system is used for reimbursement. This study aims to determine incidence of clinical coding errors among 464 patient’s medical records (PMR). An independent senior coder was appointed to review the selected PMRs and the clinical codes. Post-audit evaluation shows that 89.4%(415/464) of the records contained at least one coding error in the assignment of diagnosis or procedure codes. Error in secondary diagnosis code was the highest comprising 81.3% (377/464) of the records. Coding errors were particularly found in O&G discipline comprising 94.8% (110/116) of the selected records. These errors caused a potential loss of RM 666,461 for the hospital. The highest pre-and post audit variance of potential income was RM 568,403 for paediatric discipline. The hospital should carry out regular monitoring of quality of clinical coding in order to prevent loss of income in the future when the reimbursement of services is linked to coding of diagnosis and procedures.