National Health Technology Assessment Institute, CNPq, Porto Alegre, RS, Brazil.
School of Technology, PUCRS, Porto Alegre, RS, Brazil.
Eur J Health Econ. 2019 Nov;20(8):1133-1145. doi: 10.1007/s10198-019-01085-8. Epub 2019 Jul 8.
Micro-costing studies still deserving for methods orientation that contribute to achieve a patient-specific resource use level of analysis. Time-driven activity-based costing (TDABC) is often employed by health organizations in micro-costing studies with that objective. However, the literature shows many deviations in the implementation of TDABC, which might compromise the accuracy of the results obtained. One reason for that can be attributed to the non-existence of a step-by-step orientation to conduct cost analytics with the TDABC specific for micro-costing studies in healthcare. This article aimed at exploring the literature and practical cases to propose an eight-step framework to apply TDABC in micro-costing studies for health care organizations. The 8-step TDABC framework is presented and detailed exploring online spreadsheets already coded to demonstrate data structure and math formula building. A list of analyses that can be performed is suggested, including an explanation about the information that each analysis can provide to increase the organization capability to orient decision making. The case study developed show that actual micro-costing of health care processes can be achieved with the 8-step TDABC framework and its use in future researches can contribute to increase the number of studies that achieve high-quality level in cost information, and consequently, in health resource evaluation.
微观成本研究仍需要方法指导,以实现针对患者的资源使用水平分析。时间驱动作业成本法(TDABC)常被医疗机构用于微观成本研究,以实现该目标。然而,文献表明,在 TDABC 的实施过程中存在许多偏差,这可能会影响结果的准确性。造成这种情况的一个原因可能是缺乏针对医疗保健微观成本研究的 TDABC 进行成本分析的逐步指导。本文旨在通过探索文献和实际案例,为医疗保健组织的微观成本研究提出一个应用 TDABC 的八步框架。本文提出并详细探讨了已编码的在线电子表格,以展示数据结构和数学公式的构建。还提出了可以进行的一系列分析,并解释了每项分析可以提供的信息,以提高组织指导决策的能力。所开发的案例研究表明,使用 8 步 TDABC 框架可以实现医疗保健流程的实际微观成本核算,并且未来的研究可以有助于增加达到高质量成本信息水平的研究数量,从而提高卫生资源评估的水平。