[The cost of quality assurance]

This paper views quality assurance costs as appraisal costs. We used cost accounting techniques to estimate the cost of quality assurance activities in a large university affiliated Veteran Administration Medical Center. In addition to the personnel employed full-time for quality assurance activities, all other employees in or directly in support of clinical services were interviewed in order to determine the per cent of their work time devoted to specific quality assurance activities. The per cent time committed was multiplied by the salary and benefits package for each employee and the total computed for the facility. In addition, non-salary overhead expenses were estimated by multiplying the salary and fringe benefit costs to the ratio of total medical center non-personnel costs to total medical center costs. We found that 3.39 per cent of the total budget or $4,884,775 was devoted to quality assurance activities. The highest costs aside from the designated quality assurance personnel were for pharmacy, Laboratory, extended care (including nursing home), psychiatry, and nursing services. We did not attempt a formal benefit analysis. We concluded that quality assurance activities in a major medical center are not free. Careful cost accounting studies should be performed both to determine the cost of quality assurance and to identify its specific benefits.