Hur skall den totala vårdkostnaden för en hjärtprodukt beräknas? : En fallstudie av tre hjärtprodukter vid Hjärt- och Medicincentrum på Universitetssjukhuset i Linköping

Sammanfattning: This thesis, in the field of healthcare logistics, has been carried out at Hjärt- och Medicincentrum (HMC) at the University Hospital in Linköping during the fall and spring of 2012/2013. The thesis is done by two students at Linköping University at master’s level within the framework of Industrial Engineering and Management. As Sweden's county councils should not make a profit or loss, it is important that the councils are aware of how much care processes cost. Kardiologiska kliniken at HMC in Östergötland’s county council is one of the clinics that are profitable. One reason for this is believed to be that the care processes related to patients outside the county, are billed at a higher rate than the actual cost. The aim of this project is to create a spreadsheet template for how the total cost of care shall be calculated for cardiovascular sicknesses, and to calculate the total cost of care for three types of cardiovascular sicknesses. First a rough flow chart of the three cardiovascular sicknesses PTMV, Mitraclips and TAVI, were done in a pilot study. This was done so that the authors better would understand the sicknesses, and to create a first, rough overview of what could be included in the spreadsheet template. This, together with literature about flow charts and Activity Based Costing, decided how detailed the data collection phase would be. Through further interviews and observations a more detailed flow chart of activities could be created for each of the three sicknesses before a merged flow chart was constructed. Interviews were conducted with all categories of personnel involved, to create an accurate map as possible. By using the income statements for Seldingerenheten and Kardiologiska kliniken, and the economy cube and KPP cube of the county council, costs have been identified to either be allocated directly to the sicknesses, spreadsheet objects, or indirectly through the identified activities. The Activity Based Costing generated an expense of 110 376 SEK for PTMV, 356 669 SEK for Mitraclips and 432 159 SEK for TAVI. When comparing these costs with the previous calculated sickness type costs in the KPP cube, it showed that the developed spreadsheet template expects high with 7 000 to 13 000 SEK for the sickness types. This means less than 7% of the current cost. The estimated total cost is considered to be reliable enough to use for a rough calculation of the cost for the three types of sicknesses. Based on the Activity Based Costing a spreadsheet template was created involving how the total cost of care can be calculated. The template includes six overall steps to, in a general way, calculate the cost of care for a sickness type. The first step involves making a flow chart of the type to identify activities. The next step involves that costs must be identified in existing accounting systems, so these, in the third step, can be divided into the six cost items "Staff", "Local", "External Examinations", "Material & Medicine", "Computing & IT" or "Other", depending on where they best fit. In step four, the costs identified as directly linked to the sickness shall be distributed by using KPP or other bases. Then, the remaining costs will be distributed to the identified activities in step five, and in the last step, these costs of the activities will be allocate to the sickness type. The developed spreadsheet template can, according to the authors, be generalized to be useful in other areas in order to easily calculate the total cost of care for a sickness type in the Swedish health care. Its weakness, however, is how many clinics’ costs that are analysed. In this study only the costs of Kardiologiska kliniken finance system was analysed. A more accurate cost would be calculated if costs of other clinics also were examined, instead of being picked directly from the KPP cube. Despite this, the authors consider that the template is useful for a rough estimation of the total costs for different types of sicknesses.