![]() In this context, micro-costing studies in the perspective of public health reference centers are probably the best estimative of the real cost of a technology for the Public Health System. With the increasing use of contracts which include global budgets for public health care providers, the reimbursement table does not necessarily reflect either SUS’ expenditure or provider’s costs. SUS is financed through tax collection without any patient co-payment or flat-rate and payments to hospitals are based on a government reference table, which lists all procedures/treatments reimbursement values. īrazil provides public health coverage (Sistema Único de Saúde – SUS) ensuring universal access to health. The literature recommends the use of TDABC not only because of its capability to drive cost evaluations but also because it can be a strong tool with which to identify inefficiencies and opportunities to improve patients’ flow of care and resource utilization. TDABC offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. Time-driven activity-based costing (TDABC) is a microcosting technique applied to generate accurate patient-level cost information within the episode of care by estimating two factors: the capacity cost rate (CCR) of a resource and the period in which the resource is used. Little evidence currently exists about the cost of inpatient care for COVID-19 patients. Having valid patient-level costs for COVID-19 care is necessary to inform and evaluate hospitals’ resource allocations and care delivery decisions. A study of COVID-19 related care at 10 hospitals in Brazil showed high variability in inpatient care management and resource needs. Hospitals used varying strategies to increase their capacity to care for the influx of COVID-19 patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.ĬOVID-19 was detrimental to the financial well-being of healthcare systems. ![]() This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. All care pathways that included the ICU unit registered a higher cost per patient. The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637 23,373) and mean cost per patient of I$17,709 (SD 16,020). The median cost per patient was I$2879 (IQR 1215 8140) and mean cost per patient was I$6818 (SD 9043). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient ( p < 0.001) when compared to Emergency + Ward. ![]() Patients followed five different care pathways, of which Emergency + Ward was the most followed ( n = 118, 57%). ResultsĪ total of 208 patients were included in the study. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification. ![]() Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients’ care needs. ![]()
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