Cost identification and analysis for the extraction of plasma in the Blood Bank of Cienfuegos. Cuba.
Reyes Hernandez, Reynier ; Becerra Suarez, Keitel ; Gomez Alfonso, Elizabeth 等
INTRODUCTION
Blood is not simply "a red liquid that flows through the veins
and arteries" [Alvero, F., 1979, p. 733] (1) it is also the
component of the human body that allows all the organs to work as a
result of its circulation through the arteries, veins and capillaries.
The main functions of blood are: transporting hormones, move oxygen
and nutrients to the cells and extract from the cells all the waste
products.
It intervenes also in the balance of acids, bases, salts and water
inside the cells, it is involved in regulating the temperature of the
cooling body organs such as the liver and muscles that produce excess
heat, and as heat the skin, while components such as white blood cells
are a critical means of defense against bacteria and other pathogens,
and coagulation methods that prevent the loss of valuable liquid. All of
these are enough reasons to value the importance that blood represents
in the human body.
"Blood is a liquid tissue that covers the body and cells
carrying all the necessary elements to perform vital functions and a set
of very complex and important functions for life" [Ballester, J.,
2004, p.5] (2).
The demand of blood and blood products is increasing. The increase
of accidents, the creations of intensive care units and the needs of
some patients who were previously considered unrecoverable, are some of
the elements that have led to this enhancement.
To respond the needs and demand of blood and blood products, health
institutions worldwide rely on donations of blood and plasma or
platelets.
"Plasma is the liquid part of the blood and represents the 55%
of the total blood volume. Mainly it consists in proteins, like
immunoglobulin, clotting factors and minerals which are essential
ingredients for proper functioning of the body. The demand of plasma is
very high, not only because of the needs of transfusions in hospitals,
also because the pharmaceutical industry produces many products from
plasma as feedstock, or gamma-globulin, albumin, ant hemophilic factor
VIII, among others. Plasma is used in patients with severe burns,
coagulation disorders, liver disease, major bleeding, among other
cases" [Alfonso, M.E., 2002a, p.2] (3).
"Cells Platelets are essentially involved in blood clotting.
If these cells are missing or the number of them is low, there will be
bleeding. On the other hand, they have the special feature (or
disadvantage) of living a few days, so who has a lack of them need
transfusions every 2-3 days, which is why some patients, as some cases
of hematological patients or transplant may need several hundred units
of platelets during their treatment. Platelets are used in patients with
leukemia, a plastic anemia, cancer, transplant, and so on"
[Alfonso, M.E., 2002b, p.3] (4).
The process that accompanies a donation is strictly rigorous,
comprehensive and complicated, since it starts from the analysis,
testing and verification of the suitability of the donor, and then
starts the work carried out at the Blood Bank.
Due to the particularities of the components and the blood
derivatives, the worldwide procurement of them has high costs. Today
thousands of people die every day simply because of not being able to
have donated blood, plasma or platelets at the right time.
Cuba, within this global context, in spite of the economic,
military and financial situation imposed by the Government of the United
States for more than fifty years, is known for having blood banks where
they are offered for free, immediate and unlimited quantities of these
components that any person requires.
However, the whole production process for a bag of blood, plasma or
platelets extraction is completely taken over by the revolutionary
government, without receiving any monetary compensation, only the
recognition of the people and their health.
The costs in the health sector have always been fundamental for the
control of resources that are assigned to improve the quality and
standard of living of the population; however, in the Provincial Blood
Bank of Cienfuegos, and in any of its kind in the country, which are
institutions subordinate to the Ministry of Public Health (MINSAP), it
is possible to know the cost of producing a bag of blood or plasma,
since the accumulation of extraction and production costs resulting from
the blood, plasma or platelets, are made globally without any type of
specific production; so all the resources that are sacrificed in the
production are accumulated to one expense account without specifying its
involvement in the final product, which constitutes an obstacle to the
successful development of the planning and control of resources
allocated for this purpose and therefore negatively impacts the economy
because it does not represent the cost method of production derived from
blood donations, plasma or platelets relevant and accurate elements to
perform a correct decision.
Because of this problem it is necessary to reach the productions
cost arising from the blood in Cienfuegos Provincial Bank.
The hypothesis is described as follows: with the design and
implementation of a procedure for determining the costs of production
arising from the blood in Cienfuegos Provincial Bank, is possible to
know the unit cost of the same. This hypothesis is validated through the
design and implementation of a procedure for the determination of plasma
extraction costs in the Provincial Blood Bank of Cienfuegos,
constituting this production with increased incidence and involvement
within this institution. The main objective is to establish a procedure
for determining the costs of production arising from the blood in the
Provincial Bank of Cienfuegos.
The specific objectives are:
1. Assess the state of the science on cost accounting and its
implementation in Cuban health institutions.
2. Demonstrate the need for costing by production in the Provincial
Blood Bank of Cienfuegos.
3. Design a procedure for determining the costs of production
arising from the blood in the Provincial Bank of Cienfuegos.
4. Apply the proposed procedure for the extraction of plasma in the
Provincial Blood Bank of Cienfuegos.
DEVELOPMENT
The costs in the Blood Banks
It is necessary to execute the derivatives blood productions
costing generated in blood banks, especially when those elements are
incorporated into patients for certain treatments, operations or medical
care; also, these are raw materials for the productions of other
medicines or treatments.
The Cuban Ministry of Public Health, has establish for the Blood
Banks only the existence of a general expenses account where are
recorded all costs and expenses relating to materials, salaries, drugs,
fixed assets, equipment, tools; so, all the expenses of the institution
are charged to a single account, and then distributed by cost center.
[Reyes y Perez, 2009, p.22] (5).
These accounting procedures do not allow the determination of the
productions cost of the derivatives blood, because they cannot identify
each cost element with the productions results.
Diagnosis of the situation of the costs in the Provincial Blood
Bank of Cienfuegos and design procedure for the determination of costs
Economic events that occur in the execution of the activities of
this institution are listed chronologically based on accounting
registration techniques.
"These facts are reflected in the primary document, which
begins with a process for making accounting journal vouchers that are
based on them, which are written down in different classification
subsidiary records for accounts. Subsequently, the results are passed to
the general ledger and the corresponding sub-ledgers, including the
cost. However, this sub-mayor cost is not directly usable for
determining the cost of each organizational area of the institution
"[Ministry of Public Health of Cuba, 1960, 61] (6).
Hospital Costs Handbook, issued by the Cuban Ministry of Public
Health, contain all the currently cost activity of the different health
institutions in Cuba, and suggests the need to incorporate the cost of
blood, in order to determine the actual expenses for a specific period,
trough cost centers related to blood products.
As the Provincial Blood Bank of Cienfuegos has not an adequate
system to accumulate costs, it is only able to perform statistical
reports that are issued by all cost centers and processed in the
accounting department at the end of each month, in which it sets out how
much has been spent for different items.
The following list shows the expenses account, with their
respective sub-item, which are used for recording and accumulation of
costs and expenditure information. Current Expenditure of the Entity
-- Salaries and accrued vacation
-- Social Security Contribution
-- Taxes for the use of workforce
-- Food, clothes and lingerie
-- Medicines and medical products
-- Other expenses (Fuels, lubricants, electricity, other
productions expenses, others)
-- Depreciation of tangible fixed assets
Although this institution already has its defined cost centers and
accounts where are recorded each of the operations that are performed,
they are unable to define the total costs and expenses, which are all
recorded in the current cost account of the entity, the amounts that
correspond to different types of production.
For that reason, we proceed to design a procedure for determining
the costs of production arising from the blood in the Provincial Bank of
Cienfuegos.
The method proposed consists of four phases, which take place in
stages as shown in Figure 1.
Figure 1. Determination of the costs procedure. Blood
Blanks Productions Source: Own Elaboration
Stage No 1: Prepare Procedure Map
Stage 1.1: Make a written description of the general procedure
Stage 1.2: Prepare a Flowchart of the general process
Stage No 2: Establish different departments for each process
Stage 2.1: Define direct--indirect cost centers
Stage 2.2: Establish tools for the correct cost registration
Stage No 3: Define costs for each process
Stage 3.1: Define direct cost for each process
Stage 3.2: Define indirect cost for each production process
Stage 3.3: Define tools to assigned indirect costs
Stage 3.4: Accumulate cost elements for each production unit
Stage No 4: Prepare cost production final report
Stage 4.1: Assign to the final products the different costs
from the administrative and service department
Stage 4.2: Publish cost production final report
With this procedure it is possible to obtain the cost of
productions for each blood product that are held in the Provincial Bank
of Cienfuegos.
Following are the main final results of its application for the
extraction of plasma in the Provincial Blood Bank of Cienfuegos.
Costing for extraction processes in the plasma
Figure 2 shows the process diagram for the extraction of plasma for
Cienfuegos Provincial Bank.
[FIGURE 2 OMITTED]
Costing for direct processes
Plasmapheresis Process:
This process makes the extraction of blood to the donor, obtaining
two pilot tubes and a kit (bag plasmapheresis donation), which pass
together with the proper and relevant documentation to different areas
of laboratories for analysis; the plasmapheresis process requires of the
following direct materials; filter and kit, from those who take the
required amount multiplied by the cost of acquisition unit, and
determine the material cost up to $16.78.
Regarding the use of direct labor, the process requires 1 Medicine
specialist, 1 Nurse, 1 Laboratory technician. Of those who have taken
the basic salary, the percentage accumulated corresponding to pay leave
and their contribution to social security (12.5%) and workforce (25%) to
give a monthly salary cost, which is assigned to the product taking in
count the time that each of them invests in the process, in this case
the cost, is $6.61.
Regarding the indirect cost, in this process the use of different
material are considered indirect because they are too difficult to
identify in the product, from those who have taken the monthly costs
assigned to each cost center as well as for depreciation of tangible
fixed assets, electricity and water consumed by the Parenteral cost
center (where this process takes place), defined according to studies by
the Blood Bank of Cienfuegos Provincial and cargo capacity, also
considered indirect wage costs, cleaning and others that affect
production. These amounts have been distributed among the number of
donors on average are handled in a month at this institution, giving a
cost of indirect donor for this process $3.89, being the number of
donors average distribution base for indirect elements in this process.
Accumulating the material cost, direct labor cost and indirect
production cost; the cost of plasma per donor for the extraction service
that derivate form the Plasmapheresis process in the Blood Bank of
Cienfuegos is $27.30.
The same procedure is followed for the rest of the processes that
directly affect the extraction of plasma in the blood bank of Cienfuegos
Provincial whose results are shown below:
Sample Spinning Process:
In this process the collected sample (one of the pilot tubes) is
centrifuged, obtaining as result two pilot tubes and one balita, which
have to continue with the process and analysis of the sample. The cost
per donor in this centrifugation process is $21.83.
Serology Process:
This process receives one of the tubes obtained from the centrifuge
registering each of the operations that are carried out and their
results, which are sent to Control and Quality Assurance. The cost per
donor in this process for the extraction of plasma is $ 10.42.
Laboratory Addition Process:
This process takes place in the Clinical Laboratory cost center,
you get the vial centrifugation of the sample, determine the
sero-epidemiological evidence, the results are duly recorded and sent to
quality, all of this with a sample are send to a blank blood to end the
exams. The cost per donor in this process for the extraction of plasma
is $ 13.61.
Immune-hematology Laboratory Process:
In this process, which also takes place within the Clinical
Laboratory cost center, you receive one of the tubes and the
documentation issued by the centrifugation of the sample and they give
you several tests necessary to the same, the results are documented and
sent to Quality. The cost per donor in this process for the extraction
of plasma is $ 66.23.
Clinical Laboratory Process:
This process receives one of the tubes generated in parenteral and
performing various tests, which are documented appropriately and sent to
quality. The cost per donor in this process for the extraction of plasma
amounts to $ 8.34.
Quality Assurance Process:
This process receives the kit that is the result of the extraction
process with all the results and documentations that were made
previously in other laboratories (serology, short, and clinical
immune-hematology), analyze the quality of the sample and the rest exams
and then all the results documentation are sent for blood service. The
cost per donor in this process for the extraction of plasma is $ 0.56,
since it only requires five minutes per sample by an inspector of
tradability, and other indirect costs are not significant.
Blood Service Process:
This process receives the bag, the kit as the rest of the samples
properly documented, dispatching the kit obtained in the extraction,
registering the entire final process and dispatching to the appropriate
sectors. The same is incurred a cost of $ 3.14, constituting the largest
amount of direct labor at $ 1.90, because of the incidence of a
Specialist and a Blood Service Technician.
After having determined the unit costs for each of the direct
processes that are involved in the extraction of plasma in the
Provincial Blood Bank of Cienfuegos, you may accumulate all this
information and submit the cost report for the extraction of plasma.
Here are summarized for all processes materials consumption (amount used
for a donor multiplied by the unit cost of items), direct labor (staff
time directly working on each direct process for the extraction of
plasma multiplied by the hourly rate) and distributed through indirect
allocation bases. Results shown in Table 1.
Finally, for the Final Report of the production costs for the
extraction of plasma in the Provincial Blood Bank of Cienfuegos there
only remains the distribution of the administrative and service costs to
the final products through direct allocation method, that is, monthly
costs are taken and recorded on each of them and are apportioned between
the amounts of donations of all kinds, because those departments serve
all donors of blood, plasma, platelets attending the Provincial Blood
Bank of Cienfuegos and that amount will be added to the costs already
calculated for the extraction of plasma. All this is shown in Tables 2
and 3.
Following is graphically shown how each process affects the final
cost of the extraction of plasma in the Provincial Blood Bank of
Cienfuegos.
As shown in the cost of extraction of plasma in the Provincial
Blood Bank of Cienfuegos, the process of higher incidence is being
carried out in the Clinical Laboratory Cost Center and that has to do
with the Immune-hematology.
This procedure allows to determine the costs of extracting plasma
Provincial Blood Bank of Cienfuegos, disaggregating total costs recorded
as current expenses of the Bank, the amounts corresponding to this blood
derivative production. The same applies perfectly to all productions
blood derivatives that are held in this institution and those of its
kind in the country.
Validity of the proposed procedure
Below is a summary of the results obtained in this research and its
comparison with all that, up to now, were being reported by the entity
under study. The Provincial Blood Bank of Cienfuegos, delivery its
productions of blood, plasma, platelets and other derivatives as
predetermined costs that exist from the decade of 1980-1990 and are
shown in Table 4.
But actual costs playback blood derivatives are not to be
predetermined as this research has shown that only the plasma extraction
yields a cost of $158.90.
CONCLUSION
* The cost information must respond to the needs of the management
of the entities and the country, in a way that supports the processes of
planning, control and decision making.
* The Blood Bank of Cienfuegos Provincial cannot determine the cost
of production of blood derivatives.
* The proposed procedure allows to determine the cost of extraction
of Plasma in Provincial Blood Bank of Cienfuegos.
* The information currently reported on the costs of production
arising from the blood does not reflect current costs which are incurred
to obtain them.
BIBLIOGRAPHICAL REFERENCES
(1) ALVERO, F. (1979). Cervantes Diccionario Manual de la Lengua
Espanola. Tomo I. Ciudad de la Habana, Editorial Pueblo y Educacion, p.
733.
(2) BALLESTER, J. "La sangre en el cuerpo humano".
Revista cubana de Hematologia. Inmunologia y Hemoterapia. Enero-Marzo de
2004, Volumen 15, Ano 2, No 5, p. 5.
(3) ALFONSO, M.E. "La donacion de Plasma y plaquetas".
Revista cubana de Hematologia. Inmunologia y Hemoterapia.
Septiembre-Diciembre de 2002a, Volumen 18, Ano 3, No 2, p. 2.
(4) ALFONSO, M.E. "La donacion de Plasma y plaquetas".
Revista cubana de Hematologia. Inmunologia y Hemoterapia.
Septiembre-Diciembre de 2002b, Volumen 18, Ano 3, No 3, p. 3.
(5) REYES, R. (2009). Determinacion de los costos por pacientes en
instituciones hospitalarias cubanas. Su aplicacion en el hospital
provincial de Cienfuegos. Tesis de maestria en contabilidad de gestion.
Universidad de la Habana--UH, p. 22.
(6) MINISTERIO DE SALUD PUBLICA. (1990). Manual de costos
hospitalarios. La Habana. Cuba, p. 61.
BIBLIOGRAPHY
Please refer to articles Spanish Bibliography.
Reyes Hernandez, Reynier
Facultad de Ciencias Economicas y Empresariales
Universidad de Cienfuegos Carlos Rafael Rodriguez
Cuatro Caminos, Cienfuegos, Cuba
reyreyes@ucf.edu.cu
Becerra Suarez, Keitel
Facultad de Ciencias Economicas y Empresariales
Universidad de Cienfuegos Carlos Rafael Rodriguez
Cuatro Caminos, Cienfuegos, Cuba
kbecerra@ucf.edu.cu
Gomez Alfonso, Elizabeth
Facultad de Ciencias Economicas y Empresariales
Universidad de Cienfuegos Carlos Rafael Rodriguez
Cuatro Caminos, Cienfuegos, Cuba
egomez@ucf.edu.cu
Perez Falco, Grisel
Facultad de Ciencias Economicas y Empresariales
Universidad de Cienfuegos Carlos Rafael Rodriguez
Cuatro Caminos, Cienfuegos, Cuba
gpfalco@ucf.edu.cu
Perez Guevara, David
Facultad de Ciencias Economicas y Empresariales
Universidad de Cienfuegos Carlos Rafael Rodriguez
Cuatro Caminos, Cienfuegos, Cuba
dpguevara@ucf.edu.cu
Reception date:04/23/12--Approval date:05/15/12
Table 1. Unit cost of direct processes. Extraction of
plasma. Cienfuegos
Direct Materials UM Quantity Price Amount
Filter U 1 $ 13.86 $13.86
Kit U 1 2.92 2.92
Eppendorf vials Paq 1 9.87 0.009
Pilot centrifuge tube U 2 0.01 0.024
Cardiolipin Buffer U 1 0.19 0.19
(reagent)
VDRL antigen (reactive) U 1 1.26 1.26
HBsAg Confirmatory Pack. 1 unit 52.00 2.60
Kit UMELISA
Recombinant HIV Pack. 1 unit 204.00 0.42
UMELISA Kit
HCV UMELISA Kit (480) Pack. 1 unit 228.00 0.47
HbsAg UMELISA Kit PLUS Pack. 1 unit 216.00 0.45
Substrate (Reagent) jar 0.25 ml 2.99 0.006
Developer (reactive) jar 0.25 ml 2.99 0.006
Cholesterol (reagent) jar 2ml 36.35 0.605
Beta test tube jar 2ml 1.48 0.024
(reagent)
HemoTest (reactive) jar 5ml 8.72 0.363
Heparin (reagent) jar 5ml 2.63 0.109
Microhematocrit tube jar 1 11.05 0.110
Sodium Citrate jar 0.5 ml 1.87 0.007
(reagent)
Prints U 2 0.68 1.36
Special Pilot Tube U 11 0.01 0.132
Total Direct Material $24.51
Labor Cost assigned to each donor Weights $21.63
Overhead costs for patients Weights $112.75
TOTAL COST REMOVAL OF PLASMA For patient $158.90
Source: Own Elaboration
Table 2. Allocation of costs Administrative and
Service Departments to end
Departments Total Cost Donors (base Cost per donor
distribution)
Transport 849.00 425 2.00
Administrative 4652.50 425 10.95
areas
Store 790.00 425 1.86
Maintenance 653.48 425 1.54
Kitchen 2707.00 425 6.37
Cafeteria 1398.50 425 3.29
Power Plant 505.60 425 1.19
Others 310.25 425 0.73
TOTAL 11866.33 425 27.92
Source: Own Elaboration
Table 3. Incorporation of the costs assigned to the
productions processes for the extraction of plasma in
the blood bank of Cienfuegos Provincial
Processes Cost Earmarked Total unit
Plasmapheresis 27.30 27.30
Centrifugation 21.83 21.83
Serology 10.42 10.42
Laboratory Addition 13.61 13.61
Immunohematology Lab 73.67 73.67
Clinical Laboratory 8.34 8.34
Quality Asgto 0.56 0.56
Blood Service 3.14 3.14
Support Centers 27.92 27.92
Unit cost plasma extraction 158.90 27.92 $186.82
Source: Own Elaboration
Table 4. Prices of products derived from blood as
current procedure
Produce Price Produce Price
Whole blood $56.00 PRBC $30.00
Plasma 54.00 Lyophilized Plasma 55.20
Antihemophilic
Fresh frozen 48.00 Frozen Plasma 40.00
plasma
PRP 32.00 Platelet Concentrate 60.00
Leukocyte Mass 60.00 Antihemophilic globulin 54.00
PRBC 50.00 Frozen packed cells 60.00
Source: Own Elaboration, based on the cost of MINSAP Manuals
Figure 3. Plot of Plasma Extraction costs.
Cienfuegos Blood Bank
Reference:
1. Plasmapheresis 14%
2. Centrifugation samples 13%
3. Serology 10%
4. Laboratory Addition 11%
5. Immunohematology Laboratory 28%
6. Clinical Laboratory 9%
7. Quality Assurance 7%
8. Blood Service 8%
Source: Own Elaboration
Note: Table made from pie chart.
