Budgeting and controllable cost variances. The case of multiple diagnoses, multiple services, and multiple resources

This paper examines an unfavorable cost variance in an institution which employs multiple resources to provide stay specific and ancillary services to patients presenting multiple diagnoses. It partitions the difference between actual and expected costs into components that are the responsibility of an identifiable individual or group of individuals. The analysis demonstrates that the components comprising an unfavorable cost variance are attributable to factor prices, the use of real resources, the mix of patients, and the composition of care provided by the institution. In addition, the interactive effects of these factors are also identified.