Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal
Abstract Background The number of people with chronic diseases has increased globally, as has the number of chronic diseases per person. Faced with this reality, the term “complex patient” is current and actual. The healthcare costs associated with these patients are high and are expected to increas...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-07-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-09729-5 |
| _version_ | 1797778948087611392 |
|---|---|
| author | Yasmara Ortet Joana Seringa Rui Santana |
| author_facet | Yasmara Ortet Joana Seringa Rui Santana |
| author_sort | Yasmara Ortet |
| collection | DOAJ |
| description | Abstract Background The number of people with chronic diseases has increased globally, as has the number of chronic diseases per person. Faced with this reality, the term “complex patient” is current and actual. The healthcare costs associated with these patients are high and are expected to increase since most healthcare systems are not yet ready to provide integrated long-term care. In Portugal, several health institutions have made efforts to provide integrated care: case management models have been implemented to complex patients follow-up. However, studies related to cost of these programs are still limited. Therefore, a qualitative investigation was conducted, approaching the design criteria of a case study research, to design a case management program for complex patients and determine its direct costs, following the Time-Driven Activity-Based Costing methodology, in Local Health Unit setting. Method The direct costs of providing care to a complex patient involved in a case management program were determined, using the Time-Driven Activity-Based Costing methodology. A map of the complex patient was drawn, considering a standard flow in the program. Times and costs were allocated to the activities on the map, following Portuguese and international practices of case management models. Results A total of 684,45€/year is spent for each new patient in the case management program, of which 452,65€ corresponds to cost of remuneration of professionals involved; and 663,85€/year, for each patient who is in the case management program (over 1 year), where 432,05€ corresponds to cost of the remuneration of the professionals involved. Follow-up is the most costly phase (80.82%) and where more time is spent (85.62%). Conclusion The time spent by professionals and resources involved and the costs associated with each patient were obtained. The economic impact of the analysed activities was not studied, however, according to international authors, when well applied and selected, integrated care models lead to cost reduction and improved health outcomes. |
| first_indexed | 2024-03-12T23:24:52Z |
| format | Article |
| id | doaj.art-11cbe7ab15114f109541a2d60cc61970 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-12T23:24:52Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-11cbe7ab15114f109541a2d60cc619702023-07-16T11:13:17ZengBMCBMC Health Services Research1472-69632023-07-0123111210.1186/s12913-023-09729-5Application of the time-driven activity-based costing methodology to a complex patient case management program in PortugalYasmara Ortet0Joana Seringa1Rui Santana2NOVA National School of Public Health, Nova University of LisbonNOVA National School of Public Health, Nova University of LisbonNOVA National School of Public Health, Nova University of LisbonAbstract Background The number of people with chronic diseases has increased globally, as has the number of chronic diseases per person. Faced with this reality, the term “complex patient” is current and actual. The healthcare costs associated with these patients are high and are expected to increase since most healthcare systems are not yet ready to provide integrated long-term care. In Portugal, several health institutions have made efforts to provide integrated care: case management models have been implemented to complex patients follow-up. However, studies related to cost of these programs are still limited. Therefore, a qualitative investigation was conducted, approaching the design criteria of a case study research, to design a case management program for complex patients and determine its direct costs, following the Time-Driven Activity-Based Costing methodology, in Local Health Unit setting. Method The direct costs of providing care to a complex patient involved in a case management program were determined, using the Time-Driven Activity-Based Costing methodology. A map of the complex patient was drawn, considering a standard flow in the program. Times and costs were allocated to the activities on the map, following Portuguese and international practices of case management models. Results A total of 684,45€/year is spent for each new patient in the case management program, of which 452,65€ corresponds to cost of remuneration of professionals involved; and 663,85€/year, for each patient who is in the case management program (over 1 year), where 432,05€ corresponds to cost of the remuneration of the professionals involved. Follow-up is the most costly phase (80.82%) and where more time is spent (85.62%). Conclusion The time spent by professionals and resources involved and the costs associated with each patient were obtained. The economic impact of the analysed activities was not studied, however, according to international authors, when well applied and selected, integrated care models lead to cost reduction and improved health outcomes.https://doi.org/10.1186/s12913-023-09729-5Case managementIntegrated health careCostMultiple chronic conditions |
| spellingShingle | Yasmara Ortet Joana Seringa Rui Santana Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal BMC Health Services Research Case management Integrated health care Cost Multiple chronic conditions |
| title | Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal |
| title_full | Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal |
| title_fullStr | Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal |
| title_full_unstemmed | Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal |
| title_short | Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal |
| title_sort | application of the time driven activity based costing methodology to a complex patient case management program in portugal |
| topic | Case management Integrated health care Cost Multiple chronic conditions |
| url | https://doi.org/10.1186/s12913-023-09729-5 |
| work_keys_str_mv | AT yasmaraortet applicationofthetimedrivenactivitybasedcostingmethodologytoacomplexpatientcasemanagementprograminportugal AT joanaseringa applicationofthetimedrivenactivitybasedcostingmethodologytoacomplexpatientcasemanagementprograminportugal AT ruisantana applicationofthetimedrivenactivitybasedcostingmethodologytoacomplexpatientcasemanagementprograminportugal |