دانلود رایگان مقاله انگلیسی هزینه یابی مبتنی بر فعالیت زمان محور در بهداشت و درمان: بررسی مطالعاتی اصولی - الزویر 2017

abstract

Health care organizations around the world are investing heavily in value-based health care (VBHC), and time-driven activity-based costing (TDABC) has been suggested as the cost-component of VBHC capable of addressing costing challenges. The aim ofthis study is to explore why TDABC has been applied in health care, how its application reflects a seven-step method developed specifically for VBHC, and implications for the future use of TDABC. This is a systematic review following the PRISMA statement. Qualitative methods were employed to analyze data through content analyses. TDABC is applicable in health care and can help to efficiently cost processes, and thereby overcome a key challenge associated with current cost-accounting methods The method’s ability to inform bundled payment reimbursement systems and to coordinate delivery across the care continuum remains to be demonstrated in the published literature, and the role of TDABC in this cost-accounting landscape is still developing. TDABC should be gradually incorporated into functional systems, while following and building upon the recommendations outlined in this review. In this way, TDABC will be better positioned to accurately capture the cost of care delivery for conditions and to control cost in the effort to create value in health care.

4. Conclusions

TDABC is applicable in health care and can help to efficiently cost processes, and thereby overcome a key challenge associated with current cost-accounting methods. Applications were often constrained by organizational boundaries rather than spanning the full cycle of care for a medical condition. Process maps, resource inclusion, and time estimates were developedusing differentmethods, each demanding different amounts of resources and providing different levels of accuracy. Support resources were not allocated according to the model. The CCRs were calculated often at the resource level and occasionally for processes.All ofthese deviations had implications for the resulting cost of patient care.

Cost assignment through CCRs was described as more simple than ABC allocation methods, and CCRs together with contextual observations generated more accurate cost estimates, which suggests that TDABC is more able to address complexity in health care. The variation in application suggests that more can be done to address the challenges practitioners are facing. In order to improve the value of TDABC applications in health care, we offer the following suggestions.

With the exception of defining the medical condition and the CDVC, all steps are mandatory for any TDABC analysis. Applications that hope to inform bundled payment reimbursement systems, or inform operational improvement and cost reduction across the care continuum need to cost care over the full CDVC. Articles aiming to compare against or inform reimbursement tariffs should select a process aligned with the target tariff. To avoid unnecessary expenditure of resources when mapping processes and obtaining time estimates, staff or expert estimates should be used for short and low-cost activities.