Burn service costing using a mixed model methodology

The escalating cost of modern healthcare is threatening the fundamental "free at the point of delivery" principle of the UK National Health Services. A new remuneration system using a fixed tariff for pre-assigned diagnostic groups caters poorly for the heterogeneity of burn injuries. This study was to develop a system for Patient Level Costing (PLC), the first steps of which were to determine the true cost of burn care at service level.

Detailed interrogation was conducted of the cost of care in our Burns & Plastic Surgery Department. Costs were determined through the amalgamation of two fundamental methodologies: (1) Top-Down Costing (from detailed budgetary analysis for the hospital) and (2) Bottom-Up Costing (detailed itemised costing of staff, equipment, drugs, consumables & maintenance). These costs were categorised & using various apportionment tools, traced to specific care areas.

We demonstrated that the accuracy of costs derived by host organisations cannot be relied upon (our Burn Service was 62% more expensive than estimated by our host organisation), which therefore questions the accuracy of most published work on burn care costing based upon these assumptions. Using our costing model, an analysis was made of the cost of running the Department with zero activity but "open & ready for business". Costs such as drugs and consumables were thus removed. This demonstrated that despite no clinical activity, costs still remained at 90% of full occupancy cost and are thus fixed costs.

We hope application of this new system of Patient Level Costing to burn care will avoid the threatened viability of burn services imposed by changes in remuneration, although it will inevitably be an iterative process. A fuller understanding of the true cost of healthcare, facilitates service development and planning, both at a local and national level.