Volume 27, Issue 3 (Autumn-In Press 2026)
jrehab 2026, 27(3): 0-0 |
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Ethics code: IR.USWR.REC.1400.324
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Basakha M, Khorasani B, Mohaqeqi Kamal S H, Hosseini Zare S M, Mohsenzadeh S M, Azadi F et al . Costing Rehabilitation Services: Time Driven Approach based on Resource-Based Relative Value Units. jrehab 2026; 27 (3)
URL: http://rehabilitationj.uswr.ac.ir/article-1-3704-en.html
URL: http://rehabilitationj.uswr.ac.ir/article-1-3704-en.html
Mehdi Basakha1 
, Bijan Khorasani2 , Seyed Hossein Mohaqeqi Kamal *3 , Seyedeh Mahboobeh Hosseini Zare1 , Seyed Mahdi Mohsenzadeh4 , Farhad Azadi5 , Mahdieh Madani Mallak6
, Bijan Khorasani2 , Seyed Hossein Mohaqeqi Kamal *3 , Seyedeh Mahboobeh Hosseini Zare1 , Seyed Mahdi Mohsenzadeh4 , Farhad Azadi5 , Mahdieh Madani Mallak6
1- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
2- Department of Clinical Sciences, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
3- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. ,hosseinmohaqeq@gmail.com
4- Deputy of Treatment and Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
5- Department of Physical Therapy, Faculty of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
6- Student Research Community, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
2- Department of Clinical Sciences, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
3- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. ,
4- Deputy of Treatment and Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
5- Department of Physical Therapy, Faculty of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
6- Student Research Community, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Abstract: (4 Views)
Objectives: Traditional costing systems in hospitals often generate significant cost distortions and fail to reflect the true economic burden of healthcare delivery. To overcome these limitations, the Time-Driven Activity-Based Costing (TDABC) method offers a more accurate and flexible framework by emphasizing the time required to perform activities. This study applied the TDABC to estimate the actual cost of rehabilitation services for Resource-Based Relative Value Units (RBRVUs).
Materials & Methods: TDABC approach estimates the actual cost of services based on the time required to perform each activity and the unit cost of the resources consumed. This descriptive, cross-sectional, and retrospective study was conducted at Rafidah Rehabilitation Hospital during the 2022–2023 fiscal year. In the first stage, rehabilitation service delivery processes were identified and detailed process maps were developed for each service. Subsequently, data on human resources, medical equipment, physical space, support services, and other operational costs were extracted from the hospital’s financial and administrative records. The capacity cost rate for each resource was calculated based on its practical capacity and annual expenditure, while the time required to deliver each service was determined through direct observation, document review, and staff interviews. Thereafter, the cost of each rehabilitation service was calculated using the standardized RBRVU codes listed in the National Relative Value Book of Health Services. The costs of inpatient rehabilitation care packages for different disease groups were then estimated. Finally, the calculated costs were compared with the official tariffs and reimbursement rates of the Iran Health Insurance Organization.
Results: Personnel costs represented the largest expenditure, followed by contracted services and consumables. Across major patient groups—including Cerebral Palsy, Multiple Sclerosis, Stroke, Traumatic Brain Injury, and Spinal Cord Injury—the hospital’s reimbursement from Iran’s National Health Insurance covered only 79.1%, 86.7%, 83.9%, 81.9%, and 86.3% of the respective real costs.
Conclusion: The findings demonstrate that insurance reimbursement does not fully cover the actual costs of rehabilitation services. To enhance the financial sustainability of these services, tariff adjustments aligned with real cost structures are essential. Efficient cost management should be prioritized through optimized resource utilization and inventory control. Expanding non-inpatient rehabilitation programs, such as home-based or outpatient care, can also help reduce hospital expenditures.
Materials & Methods: TDABC approach estimates the actual cost of services based on the time required to perform each activity and the unit cost of the resources consumed. This descriptive, cross-sectional, and retrospective study was conducted at Rafidah Rehabilitation Hospital during the 2022–2023 fiscal year. In the first stage, rehabilitation service delivery processes were identified and detailed process maps were developed for each service. Subsequently, data on human resources, medical equipment, physical space, support services, and other operational costs were extracted from the hospital’s financial and administrative records. The capacity cost rate for each resource was calculated based on its practical capacity and annual expenditure, while the time required to deliver each service was determined through direct observation, document review, and staff interviews. Thereafter, the cost of each rehabilitation service was calculated using the standardized RBRVU codes listed in the National Relative Value Book of Health Services. The costs of inpatient rehabilitation care packages for different disease groups were then estimated. Finally, the calculated costs were compared with the official tariffs and reimbursement rates of the Iran Health Insurance Organization.
Results: Personnel costs represented the largest expenditure, followed by contracted services and consumables. Across major patient groups—including Cerebral Palsy, Multiple Sclerosis, Stroke, Traumatic Brain Injury, and Spinal Cord Injury—the hospital’s reimbursement from Iran’s National Health Insurance covered only 79.1%, 86.7%, 83.9%, 81.9%, and 86.3% of the respective real costs.
Conclusion: The findings demonstrate that insurance reimbursement does not fully cover the actual costs of rehabilitation services. To enhance the financial sustainability of these services, tariff adjustments aligned with real cost structures are essential. Efficient cost management should be prioritized through optimized resource utilization and inventory control. Expanding non-inpatient rehabilitation programs, such as home-based or outpatient care, can also help reduce hospital expenditures.
Keywords: Rehabilitation services, Inpatient services, Outpatient services, Time-driven activity based costing.
Type of Study: Original |
Subject:
Health Economics
Received: 5/11/2025 | Accepted: 17/06/2026 | Published: 23/09/2026
Received: 5/11/2025 | Accepted: 17/06/2026 | Published: 23/09/2026
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This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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