- Title
- A framework for price tariffs in the costing structures of South African private hospitals
- Creator
- Botha, Gideon
- Subject
- Medical care, Cost of -- South Africa
- Subject
- Medical economics -- South Africa Medical care -- South Africa -- Cost control Cost accounting
- Date Issued
- 2020
- Date
- 2020
- Type
- Thesis
- Type
- Doctoral
- Type
- DPhil
- Identifier
- http://hdl.handle.net/10948/50432
- Identifier
- vital:42167
- Description
- The increase of South African health care costs can be extrapolated into the global healthcare cost challenge, with various factors contributing to this problem. One of the factors viewed as being central to the rising cost of health care is the inability of health care provider organisations to accurately measure unit costs of resources used to treat a patient for their medical condition and patient outcomes. The measurement of an accurate unit cost and patient outcomes is imperative to improving value, which is seen as an improvement in outcomes for every rand spent. The determination of price tariffs and the price tariff payment model used to onward bill the price tariff for medical services have also been identified as having a central role in improving value in health care. In order for price tariffs to improve value, they should be reflective and be based on an accurate unit cost that reflects the cost of resources used to provide efficient and effective care for a patient’s medical condition. For the price tariff payment model to improve value, it needs to reward providers for delivering superior patient outcomes at a lower cost by making price tariffs contingent on achieving specified outcomes as well as incorporating performance payments or holdbacks based on outcomes achieved. This study provides a framework for price tariffs in the costing structures of South African private hospitals. Secondary research was conducted in the form of a comprehensive literature search in order to do an interpretative analysis of the strengths and weaknesses of the various combinations of unit costing models and price tariff payment models used to determine prices in private hospitals. The literature review was followed by primary research that involved three phases, all of which used a qualitative research approach. In Phase 1, primary data were collected using unobtrusive measures that consisted of a data request first, followed by unstructured interviews with representatives of Hospital A and Hospital B to obtain an analysis of the combinations of unit costing model and price tariff payment model used for a laparoscopic appendectomy. In Phase 2, data were collected by means of an unstructured interview with a surgeon describing a laparoscopic appendectomy procedure in detail and based on this process description, the approximate costs for the various resources that were sourced from different suppliers could be calculated. The data analysis and interpretation were done in three phases, with each phase having different research objectives. The data were first coded and then interpreted. In the first primary research phase, the combinations of unit costing models and price tariff payment models used by private Hospital A and Hospital B were evaluated. In the second phase, the recommended combination of unit costing model and price tariff payment model was applied to a hypothetical example and evaluated. In the final phase, based on the outcome of the first and second research phases, a combination of unit costing model and price tariff payment model for private hospitals was recommended. The results showed that the recommended combination of unit costing and price tariff payment model namely time-driven activity-based costing with the global fee price tariff payment model was the most appropriate to determine price tariffs in private hospitals when compared to the unit costing models and price tariff payment models used by Hospital A and Hospital B for a laparoscopic appendectomy. Furthermore, the recommended combination of unit costing model and price tariff payment model was found to be usable for the determination of price tariffs in the costing structures of private hospitals. The time-driven activity-based costing model and global fee price tariff payment model should be adopted or used as guidelines for determining price tariffs in private hospitals in South Africa. Price tariffs would be more transparent as they would reflect the actual resource cost of treating the patient and the resources used and treatment provided could then be assessed against the delivery value chain that charts the principal activities involved in a patient’s care for a medical condition to ensure that patient best-practice protocols are followed. The proposed framework enables the determination of price tariffs based on an accurate unit cost reflecting the actual resources used to provide efficient and effective care and also improve value for the patient.
- Format
- xviii,281 leaves
- Format
- Publisher
- Nelson Mandela University
- Publisher
- Faculty of Business and Economic Sciences
- Language
- English
- Rights
- Nelson Mandela University
- Hits: 1763
- Visitors: 1801
- Downloads: 146
Collections
NMU School of Management Sciences
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | SOURCE1 | Botha, G 20300327186 Thesis April 2020 - Loaded 9 Feb 2021 (1).pdf | 5 MB | Adobe Acrobat PDF | View Details Download |