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Dealing with Time Estimates in Hospital Cost Accounting: Integrating Fuzzy Logic into Time-Driven Activity-Based
Fiona Koster1,2, Marc R Kok3, Jaco van der Kooij4
1Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands. kosterf@maasstadziekenhuis.nl.
Pharmacoeconomics - Open
|May 2, 2023
Summary
Fuzzy logic enhances time-driven activity-based costing (FL-TDABC) for more accurate healthcare cost analysis. This method improves value-based healthcare (VBHC) by accounting for staff time variations in patient care cycles.
Area of Science:
- Healthcare Management
- Cost Accounting
- Health Economics
Background:
- Time-driven activity-based costing (TDABC) is crucial for value-based healthcare (VBHC) but faces challenges with time estimate robustness and data collection effort.
- Patient heterogeneity and multimorbidity complicate accurate time estimations in healthcare settings.
- Fuzzy logic (FL) is introduced to address time variation in TDABC, creating the FL-TDABC methodology for more efficient parameter estimation.
Purpose of the Study:
- To apply the FL-TDABC methodology to estimate the costs and cost drivers of the Rheumatoid arthritis (RA) care cycle.
- To compare FL-TDABC cost estimates with traditional TDABC and Activity-Based Costing (ABC) methods.
- To assess the potential of FL-TDABC in supporting the transition to value-based healthcare.
Main Methods:
- A standardized care path for Rheumatoid arthritis (RA) was used to calculate annual per-patient costs and cost drivers.
- Cost data from 2018 was sourced from a Dutch hospital, including financial, HR, and business intelligence reports.
- Time estimates were gathered through medical staff interviews, and care activities were extracted from electronic health records.
Main Results:
- The FL-TDABC methodology estimated annual RA care cycle costs at €1497 per patient.
- Cost variations within the RA cycle ranged from €1317 to €1684 (22% difference), primarily driven by rheumatologist consultations and pharmacy costs.
- Traditional TDABC and ABC methods yielded higher annual costs of €1609 and €1604 per patient, respectively.
Conclusions:
- FL-TDABC provides more precise and efficient cost estimates by incorporating the subjective nature of healthcare time data.
- The methodology offers valuable insights into practice variations, facilitating the shift from volume-based to value-based healthcare systems.
- FL-TDABC enhances the practical application of TDABC in complex healthcare environments.
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