Andalusian School of Public Health/Escuela Andaluza de Salud Pública (EASP), Granada, Spain.
University of Granada, Granada, Spain.
Eur J Health Econ. 2020 Jun;21(4):529-542. doi: 10.1007/s10198-019-01157-9. Epub 2020 Jan 20.
According to the most traditional economic evaluation manuals, all "relevant" costs should be included in the economic analysis, taking into account factors such as the patient population, setting, location, year, perspective and time horizon. However, cost information may be designed for other purposes. Health care organisations may lack sophisticated accounting systems and consequently, health economists may be unfamiliar with cost accounting terminology, which may lead to discrepancy in terms used in the economic evaluation literature and management accountancy. This paper identifies new tendencies in costing methodologies in health care and critically comments on each included article. For better clarification of terminology, a pragmatic glossary of terms is proposed. A scoping review of English and Spanish language literature (2005-2018) was conducted to identify new tendencies in costing methodologies in health care. The databases PubMed, Scopus and EconLit were searched. A total of 21 studies were included yielding 43 costing analysis. The most common analysis was top-down micro-costing (49%), followed by top-down gross-costing (37%) and bottom-up micro-costing (14%). Resource data were collected prospectively in 12 top-down studies (32%). Hospital database was the most common way of collection of resource data (44%) in top-down gross-costing studies. In top-down micro-costing studies, the most resource use data collection was the combination of several methods (38%). In general, substantial inconsistencies in the costing methods were found. The convergence of top-down and bottom-up methods may be an important topic in the next decades.
根据最传统的经济评估手册,所有“相关”成本都应纳入经济分析,考虑到患者人群、环境、地点、年份、视角和时间范围等因素。然而,成本信息可能是为其他目的而设计的。医疗保健组织可能缺乏复杂的会计系统,因此,卫生经济学家可能不熟悉成本核算术语,这可能导致经济评估文献和管理会计中使用的术语不一致。本文确定了医疗保健成本核算方法的新趋势,并对每篇纳入的文章进行了批判性评论。为了更好地澄清术语,提出了一个实用的术语词汇表。对 2005 年至 2018 年的英文和西班牙文文献进行了范围综述,以确定医疗保健成本核算方法的新趋势。检索了 PubMed、Scopus 和 EconLit 数据库。共纳入 21 项研究,产生了 43 项成本分析。最常见的分析是自上而下的微观成本分析(49%),其次是自上而下的总费用成本分析(37%)和自下而上的微观成本分析(14%)。在 12 项自上而下的研究中(32%),前瞻性收集了资源数据。在自上而下的总费用成本分析研究中,医院数据库是最常见的资源数据收集方式(44%)。在自上而下的微观成本分析研究中,最常见的资源使用数据收集方法是多种方法的结合(38%)。总的来说,发现成本核算方法存在很大的不一致性。自上而下和自下而上方法的融合可能是未来几十年的一个重要课题。