What a Visit Actually Costs: Consumables, Time & the Service Mix
A clinic can be busy, well-run and quietly losing money on half of what it does, because consumable cost per visit is never calculated. How to build the number from records you already keep, and what it usually reveals about your service mix.
Ask a clinic manager which service is most profitable and you will get an answer. Ask how they know and the answer is usually revenue — the service that bills most. Revenue is the easy half. The consumables, the staff time, the equipment sitting idle between uses and the stock that expired unused are the other half, and they are rarely attached to anything.
The result is a familiar pattern: a clinic works hard, bills steadily, and cannot explain why the bank balance does not reflect it. The explanation is nearly always in the mix — a subset of services being delivered below cost, subsidised by the rest, invisibly and consistently.
Four costs, and only one is obvious
| Cost element | How clinics usually treat it | What that hides |
|---|---|---|
| Consumables used | A monthly stores figure | Which service consumes what — the whole question |
| Clinical staff time | Salaries, fixed and unallocated | That a 40-minute procedure and a 5-minute review cost very differently |
| Equipment and its upkeep | Capital, then repairs as they arise | That a machine used twice a week still costs the same as one used daily |
| Expired and wasted stock | A write-off at the count | That the waste concentrates in specific low-volume services |
The last row deserves attention because it behaves counter-intuitively. Waste concentrates where volume is lowest — a reagent or consumable bought in a pack size suited to a busy service, used twice, and discarded at expiry. So the least-used services carry the highest waste cost per patient, which is exactly the opposite of how most people assume it works.
Waste concentrates where volume is lowest. Your least-used service is quietly your most wasteful one, and it is the one nobody is watching.
Build the number from what you already record
You do not need an activity-based costing exercise. You need a reasonable consumable cost per service type, and it can be assembled in an afternoon.
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List your services by volume, and take the top eight
The tail does not matter yet. Eight service types typically cover the large majority of a clinic's activity, and the exercise stays finishable.
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Write the standard consumable list for each
What is used for one typical instance — gloves, syringe, dressing, reagent, gown. This is a clinical conversation of about twenty minutes per service, and it is the only part that needs a clinician.
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Price the list from your own stock costs
Not from a supplier list — from what you actually paid, landed. This is where the number becomes yours rather than theoretical.
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Compare against what the service bills
Consumable cost against price is a floor, not a full margin. If a service does not clear it, nothing else in the calculation will save it.
One procedure, honestly costed
Illustrative, in KES. The useful output is not the margin percentage but the comparison across services. Once eight of these exist, the question stops being "are we profitable" and becomes "which three of these should we do more of, and which one is being subsidised by the rest?"
Reconciling issues against activity
Once a standard consumable list exists per service, a second and rather powerful check becomes available: compare what should have been consumed, given the month's activity, against what was actually issued from the store.
A persistent gap has three honest explanations — the standard list is wrong, wastage is higher than assumed during procedures, or stock is leaving for another reason. All three are worth knowing, and none of them is visible from a monthly stores total. Most clinics that run this comparison for the first time find that their standard list was simply incomplete, which is itself worth the exercise.
Issue to a department, not to the clinic
The comparison only works if stock issues have a destination — theatre, laboratory, dressing room, dental. Issuing to a named department costs seconds and converts an unusable monthly total into a per-service consumption figure. Without it, this entire calculation stays theoretical.
What the answer usually changes
Three decisions typically follow, and they are rarely the ones the clinic expected before running the numbers.
What clinics assume
- Prices need to rise across the board
- The busiest service is the most valuable
- Waste is a discipline problem
- Low-volume services are harmless if occasionally requested
What the numbers usually show
- One or two specific services are the problem, not the price list
- A high-volume, low-margin service can consume capacity that a better one needs
- Waste is mostly a pack-size and volume problem
- A rarely-used service with expiring stock can cost more than it earns, every month
The pack-size finding is the most actionable and the least intuitive. A clinic buying a reagent in the only pack size the supplier offers, using a third of it before expiry, is paying three times its assumed cost per test — and the fix is a supplier conversation or a service decision, not a staff briefing about carefulness.
What we do and do not do
What AWRA OpsHub does today
- Stock issues by department or destination, which is what makes per-service consumption computable.
- Landed cost on stock items, so the consumable figure reflects what you actually paid to have it on the shelf.
- Write-offs with reasons, so expiry and wastage are separable from ordinary consumption.
- Batch and expiry tracking, with a horizon view of what is approaching expiry.
- Purchase history and supplier performance, which is the evidence for a pack-size or supplier conversation.
- Reporting on issues and costs, schedulable to whoever runs the monthly review.
What it does not do
- Not an EMR or a practice management system. There is no patient record, no appointment book and no clinical activity count — visit and procedure volumes come from your clinical system.
- No service or procedure costing model. The standard consumable list per service is yours, maintained outside the system; nothing holds a bill of materials for a procedure.
- No billing or claims handling. Insurer claims, capitation and patient billing are not part of this.
- No automatic activity-to-consumption reconciliation. The comparison described above is a monthly analysis you run, not a report that exists.
The boundary is consistent and worth stating once: activity comes from your clinical system, cost comes from here, and the comparison is a monthly exercise by a person. That is a genuine limitation — and it is still considerably more than most clinics have today.
Our take
Issue stock to departments rather than to the clinic, write a standard consumable list for your top eight services, and price it from landed cost. One afternoon produces a floor price for each service and, almost always, one uncomfortable discovery about a low-volume service whose expiring stock costs more than it earns.
See inventory for clinics
Stock issued by department, landed costs on items, batch and expiry tracking, and write-offs with reasons you can separate from consumption.
Explore inventoryFrequently asked questions
Do we need patient-level costing to do this?
No, and attempting it is how the exercise never finishes. A standard consumable list per service type, priced from your own landed costs, gets you most of the insight for a fraction of the effort. Patient-level variation matters clinically and rarely changes the commercial conclusion, which is usually about a service or a pack size rather than about individual cases.
Where do the visit and procedure volumes come from?
Your clinical or practice management system — there is no patient record, appointment book or activity count here, and this is not an EMR. In practice this means one number per service type typed into a monthly review, which is a real limitation and still leaves you far ahead of a clinic working from a single monthly stores total.
Why does our stores figure not match what services should have used?
Three honest possibilities, and the first is the most common: the standard consumable list is incomplete, because it was written from the procedure rather than from what actually gets opened. The second is that in-procedure wastage is higher than assumed. The third is that stock is leaving for another reason. Running the comparison monthly narrows it down quickly, and the first two are usually fixed within a quarter.
How do we reduce expiry waste on low-volume services?
Attack the pack size before the discipline. Waste concentrates where volume is lowest, and the usual cause is buying a reagent or consumable in a pack sized for a busy service and using a third of it. The conversations that actually help are with the supplier about smaller packs or more frequent delivery, and with yourselves about whether a rarely-requested service earns the stock it ties up. Staff carefulness is rarely the binding constraint.
Should we raise prices if a service does not cover its costs?
Sometimes, but check the mix question first. A service that fails on consumable cost alone has a pricing or a pack-size problem. A service that clears consumables but consumes disproportionate clinical time may be crowding out something better, in which case scheduling changes what a price rise cannot. The value of costing eight services rather than one is precisely that it shows you which of those two situations you are in.
