Reimbursement rate determination for home-visit oral health care services using Time-Driven Activity-Based Costing

Objectives: This study aimed to quantify the actual resource utilization and cost structure of homevisit oral health care services using a Time-Driven Activity-Based Costing (TDABC) approach, in response to the growing demand for efficient home-based care for older adults.Methods: An analytical framework comprising 12 domains and 78 activities, validated through a Delphi study, was applied to home-visit oral health care records.A total of 100 home-visit service logs recorded by ten dental hygienists participating in an integrated care program in Cheonan City between March and April 2024 were analyzed.Data collected included activity time, consumable supply, travel time and distance, and transportation expenses.A capacity cost rate incorporating both direct and indirect costs was used to estimate activity-level costs and total costs per visit.Results: Dental hygienists conducted an average of 6.43 visits per day.The mean travel time and distance per visit were 15.04 min and 7.31 km, respectively.Transportation expenses averaged 9,740 KRW per visit, and consumable supply costs ranged from 1,428 to 9,738 KRW per patient, depending on oral health status.The calculated capacity cost rate was 487 KRW/min, resulting in activity-based costs of 66,232 KRW per visit across the 78 activities.When transportation time costs were added (7,324 KRW; 15.04 min487 KRW/min), the total cost per visit was estimated at 73,556 KRW.Preparation and infection control activities were identified as major cost drivers. Conclusions:The TDABC approach provided a comprehensive estimate of the cost structure of home-visit oral health care services, capturing expenditures associated with travel, preparation, and documentation.These findings provide evidence to support sustainable reimbursement models within long-term care and integrated care systems.