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Developing Hospital at Home tariffs in Denmark: a time-driven activity-based microcosting approach within a
Bettina Wulff Risør1, Iben Duvald2,3, Camilla Palmhøj Nielsen4,5
1DEFACTUM, Central Denmark Region Center for Public Health and Quality Improvement, Aarhus, Denmark betris@rm.dk.
BMJ Open
|April 20, 2026
Summary
A new framework using time-driven activity-based costing (TDABC) and micro-costing was developed to determine reimbursement for Hospital at Home (HaH) services. This model accurately reflects the actual costs of providing acute elderly care at home.
Area of Science:
- Health Economics
- Healthcare Management
- Geriatric Care
Background:
- Hospital at Home (HaH) services offer an alternative to conventional hospital admission for acute elderly care.
- Developing equitable and transparent reimbursement models for HaH is crucial for its sustainable implementation.
- Existing reimbursement structures may not accurately reflect the resource utilization and complexity of home-based acute care.
Purpose of the Study:
- To develop an empirically grounded, activity-based tariff framework for Hospital at Home (HaH) services.
- To utilize time-driven activity-based costing (TDABC) and micro-costing for accurate cost assessment.
- To support transparent and equitable reimbursement for acute elderly care delivered at home.
Main Methods:
- A microcosting study was embedded within a randomized controlled trial (RCT) comparing HaH with hospital admission in Denmark.
- Resource use for HaH activities was prospectively measured using microcosting logs, time-motion observations, and administrative records for 107 elderly acute patients.
- An eight-step TDABC framework was employed to derive empirically based tariffs per HaH visit, including sensitivity analyses.
Main Results:
- The mean total tariff for first HaH visits was €338.89 and €207.81 for subsequent visits.
- Staff time was identified as the primary cost driver, with smaller contributions from equipment, overhead, and travel.
- The developed framework accounts for variations in staffing, geography, and visit intensity, enabling cost estimation across different HaH care pathways.
Conclusions:
- A transparent and reproducible tariff-development framework for HaH services was successfully established using TDABC and microcosting.
- The model aligns reimbursement with actual resource use and care complexity, enhancing fairness.
- This transferable framework serves as a valuable template for economic evaluation and operational planning of HaH services.
