Abstract：
The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient\'s concrete path during hospitalization and the length of stay was also recorded. The total inpatient cost of THA, net of all indirect costs normally included in a DRG-based reimbursement, was about EUR 6000. The observation of a total of 90 patients identified 2 main expense items: the prosthetic device alone represents 50.4% of the total cost, followed by the hospitalization, which constitutes 41.5%. TDABC has proven to be a precise method for determining the cost of the healthcare delivery process for THA, considering facilities, equipment, and staff employed. The process map made it possible to identify waste and redundancies. Surgeons should be aware that the choice of prosthetic device and that a lack of pre-planning for discharge can exponentially alter the hospital expenditure for a patient undergoing primary THA.
摘要：
对于初次全髋关节置换术（THA）的基于价值的支付模式的强调导致骨科医生和医院更需要更好地了解实际成本和资源使用。时间驱动型作业成本法（TDABC）是一种创新方法，可以更准确地衡量费用并解决成本挑战。它估计每种资源的时间数量和每单位时间的成本(例如，设备和人员)在整个护理过程中使用。我们的目标是了解在意大利公立医院使用TDABC的THA的真实成本，并了解采用这种方法如何从组织和财务角度增强提供医疗保健的过程。2019年期间，全髋关节置换手术所需的主要活动，涉及的运营商，并确定了术中耗材。生成过程图，以确定患者住院期间的具体路径，并记录住院时间。THA的总住院费用，扣除通常包括在基于DRG的报销中的所有间接成本，大约6000欧元。对总共90名患者的观察确定了2个主要费用项目：仅假肢装置就占总费用的50.4％，随后是住院治疗，占41.5%。TDABC已被证明是确定THA医疗保健交付过程成本的精确方法，考虑到设施，设备,和雇用的工作人员。过程图使得识别浪费和冗余成为可能。外科医生应该意识到，假体装置的选择以及缺乏出院的预先计划可能会成倍地改变接受原发性THA的患者的医院支出。
