Based on the Law of Scarcity, there will always be an infinite demand in healthcare sector however, the resources available will be limited. Limited resources can be due to limited financial budget by the policy maker. Despite limited budget, quality of treatment given should not be jeopardised. In order to provide quality treatment with limited sources, there must be a depth of knowledge on costs. Cost calculation can be an effective tool in bridging the gap between policy makers who emphasise on cost saving and the practitioners who emphasise on quality of treatment. An attempt to reduce cost should be based on an increase in efficiency, not in a decrease in quality of treatment.
ABC is known to be the most precise form of cost calculation. This is because of the detailed process of data gathering and processing instead of the tradition method where it depends on the production volume. In the traditional method, the total cost is divided by number of patients to get an average cost per patient. Using this old method, one cannot estimate the cost of different procedures. As for dental treatment, ABC seems to be the best method for cost calculation as it is purely procedural based. Using ABC, we can estimate the cost of each treatment by estimating the number of equipment, instrument and consumables used and the time taken for each treatment. In this study, we managed to gather all information via a clinical pathway and then calculated the cost based on the information obtained.
Implementing ABC in healthcare system has its own advantages. Firstly, since ABC is known to be an accurate cost calculation method, it can be a useful tool for policy makers in determining the charges of treatment for patients. Instead of setting a price range using the old costing method which is less precise, having an evident-based cost accounting data will be good for fees determination. This data will be vital for policy makers to use in future planning and budgeting of hospitals in terms of efficient allocation of health care resources to decide on the future fees in order to avoid a huge clinical burden. This also allows the policy makers to revamp the current charges based on evident-based costing especially if the present charges are under charged. As far as for dental charges in HCTM, there has not been any changes for the past 10 years or so. With a severely lower charge of fees compared to the original cost, a heavy financial burden is absorbed by the policy maker of HCTM. Secondly, ABC also has an impact in the effectiveness of treatment. Since ABC is done in a standardised and detailed manner, this helps practitioners to analyse the expenses in detail and implement improvisations that increase efficiency and quality of treatment. This helps to reduce cost by decreasing unnecessary expenses. For example, poor preparations before treatment can lengthen procedural time and this can increase cost. Besides that, in Malaysia where implementation of dental insurance is in the rise, these data will be useful for insurance company to set their insurance policy of dental treatment.
ABC can be done using various methods such as using existing clinical guidelines[9], interview, observation or by conducting a clinical pathway to lay out the routine practices performed[10]. In this study, clinical pathway was used to determine the ABC. Clinical pathway is defined as “an integrated management plans that display goals for patients, and provide the sequence and timing of actions necessary to achieve such goals”[11]. Clinical pathway is important in patient management as it reduces variations in providing treatment, and this has been proven to reduce the time spent and cost of treatment while maintaining the quality of treatment[12]. This is important to reduce the scarcity of resources available. For example, in this study, we standardised the activity and medicament used of each treatment. By doing this, we can reduce cost by 1) buying materials in bulk which is generally cheaper since all practitioners use the same consumables. 2) avoid wastage by having to discard expired consumables. This occurs when there are variations among different practitioners who use different consumables. When certain consumables are less used, it ends up getting expired and needed to be discarded. Clinical pathway has also shown to improve intra and inter-department communication, improve patient outcomes, promote patient safety and increase patient satisfaction[13].
In our best of interest, this study is the most comprehensive study regarding cost calculation of common dental treatment done under GA among paediatric patients. For dental management of different treatments of caries under GA for paediatric patients in HCTM, the cost ranges from USD 15.00 to USD 100.00. Pulpotomy has the most expensive cost. This is due to the medicament used in pulpotomy procedure which ranges far higher than any other consumables used in other treatment modalities. Furthermore, pulp therapy is a technique sensitive procedure, a longer time is needed to complete the treatment. On the other hand, extraction has the cheapest unit cost. This is because it consumes less consumables and instruments and does not require and equipment unlike other treatments. On top of that, lesser time is required to extract teeth.
This study has its own limitation. For cost calculation of this study, we calculated the cost of treatment purely based on activities done during the treatment. We did not include and pre-treatment or post-treatment cost. For example, pre-treatment costs include cost of dental examination and radiographs taken. For post-treatment, cost such as autoclaving the instruments was not calculated. Besides that, in this study, we did not calculate indirect cost such as utility cost.