Activity-based costing in healthcare
When I teach Activity-based costing (ABC), one of the example sectors often given to students is healthcare. Just in case you don’t know, ABC is a costing technique which allocates cost to products or services based on resources used by the product or service. If you think about healthcare, even in a standard medical procedure, no two patients are the same and use more or less drugs, time, hospital resources etc. Thus ABC appears useful – one patient may use more resources than the other and so cost more.
Of course, healthcare systems around the world vary. Some are fully funded by taxation, some are fully private. In Ireland, the system is mainly a public one, but unfortunately, it is not great in terms of access to treatment. So, if you can afford it, you can have private medical insurance (US style, but less costly) and this gives you more options. With this in mind, here is my recent experience which made me think about ABC and write this post.
Last year, I spent 11 days in a hospital for some heart surgery. Thankfully all is well. I am lucky enough to have health insurance. About three months post-surgery, I received an advice from my insurer stating how much the hospital had been paid – about €25,000. Phew, thankfully I did not have to find the cash for that! The advice was interesting in that showed little sign of ABC techniques – and as my hospital was one of the more advanced and modern I would have expected it to use ABC, to be honest. What the advice showed was a charge per day, with this charge being higher for two days in intensive care. Otherwise, there is little else. Unfortunately for me, I had some complications which required more drugs and attention from staff, so I took up more time and resources than some of my hospital mates (trust me, you make some good friends in hospitals). But this is not reflected in the cost. I suppose on balance things work out for the hospital and it may not matter, but to me, this simple example is a prime case where ABC could be used easily. If it were, then maybe health insurance costs would be a lot less in some cases – but that’s a whole other debate.
Having said all of the above, research on ABC use shows it is often less than 20% in practice. So maybe I should not be expecting its use in my hospital at all.