”Strategies for the use of
case costing/cost accounting”
Basic idea and examples
Case costing/cost accunting, 2016-05-19, Göran Atterfors
Östergötland
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Östergötland is the fourth most
populous region of Sweden
Approximately 442,000 people
call Östergötland their home
The region houses 13 different
municipalities
High ranked health-care system i Sweden
Three hospitals:
– University Hospital in Linköping
– Vrinnevi Hospital in Norrköping
– Motala Hospital
43 health centres
Part of the health-care region in
Southeast Sweden
Model (short summary)
Provider
Client (purchaser)
Regional executive board
Healthcare committee
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As a type of government,
the Regional Executive
Board directs and
coordinates the various
services
”Production organization”
The providers are
responsible for ensuring
that inhabitants have access
to approved services
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The task of the Healthcare
Committee is to identify the
needs and preferences of
inhabitants when it comes to
health and dental care
The committee allocates
financial resources for
healthcare services and
purchases the services from
both public and private
providers
Case costing – the method
Patient related
costs
Total costs
Base costs
Care episode
5
Cost accounting – the concept
first some basics
- Idea
- ”On demand”
- Decentralization
- Continuity
6
The concept
Quality standards of the case costing system
Provider perspective
Purchaser perspective
Support for local improvement
7
Quality standards of the case costing system
”no output is better than its input ”(GI-GO)
Quality markers (ex #1)
-
8
changed DRG-codes
patient related costs quota
no matching of costs
calculation difference
Provider perspective
-Productivity
-Benchmarkning (ex # 2)
-Monitoring of agreement with other county councils (ex # 3)
-Calculation of price (pre and after)
-Income statement ”horisontally”
Analysis of the own organization, but in another dimension
9
Purchaser perspective
-Information/knowledge
-Resource allocation
-Procurement support
-Contracts
-Systems for compensation of
processes (example)
stroke
breast cancer
-Surveillance
- Valuation of systems for
compensation ? (ex # 4)
10
Support for local improvement
-Outlier (ex # 5)
-Costs for healthcare associated infections
-Is prevention profitable ?
-Cost related to quality (ex # 6)
-Prediction for ”expensive” patients > coaches
-Quality in DRG-coding
-Change of methods > effects
11
On demand
- ”The things you ask for, will be done”
- Case costing is not of its own, it is a
natural part of monitoring activities
and planning
- Ordinary reporting (but tradition of
”Income statement” is strong)
12
Decentralized
Management
-Commitment of management is
crucial !!!
Local support
-From relatively large unit (central
located) to relocation to divisions
-From local ”accountant” to
”controller”
13
Quality markers
(#1)
Quality markers
2010
2011
2012
2013
2014
Changed DRG-codes
1,6%
1,3%
1,5%
1,4%
1,5%
Patient related costs quota 19,5%
19,3%
20,9%
22,6%
21,9%
22,6%
35%
No matching of costs
0,5%
0,3%
0,6%
0,6%
0,3%
0,3%
0
Calculation difference
0,2%
0,3%
0,0%
0,1%
0,3%
0
0
14
2015
target
0
Benchmarking
(#2)
Relation to national average
Division
2010
2011
2012
2013
2014
HMC
0,95
0,95
0,96
0,93
0,94
BKC
0,78
0,76
0,85
0,82
0,80
CKOC
0,90
0,91
0,90
0,90
0,91
SC
0,92
0,92
0,90
0,90
0,88
NSC
1,08
0,96
1,05
1,07
1,12
NSÖ
0,85
0,82
0,76
0,80
0,89
NSV
0,99
0,99
0,95
1,04
NiF
1,05
1,03
0,98
15
Monitoring of agreement
with other county councils
Agreement principals
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-
16
Fixed sum for infrastructural
costs (65%)
Varied sum for provided
care (35%)
Comparison on yearly base
of income vs costs
Regulation based on
comparsion
Aim - longterm relation of
income vs costs
(#3)
Result
RJL
LKL
Income
Costs
34,9
27,0
34,4
27,6
Result
+0,5
-0,6
(mill euro)
Evaluation of systems for
compensation
SEK
age
17
(#4)
Outlier
(#5)
Customer F
Clinics
Customer H
2011
Njur
1,2
Inf
0,9
2012
2013
2012
0,2
1,2
0,1
Endo
0,1
0,1
0,1
MT
0,4
0,1
2013
0,3
EM
0,2
Kard
2,4
1,0
6,1
1,5
1,1
1,3
Thx
Division HMC
2,8
7,5
6,4
8,1
6,5
15,7
2,3
4,6
4,6
5,9
4,2
5,8
Barn
0,2
1,1
0,2
1,9
3,7
0,5
KK
1,0
0,8
0,8
1,0
0,6
0,3
Division BKC
1,2
1,9
1,0
2,9
4,3
0,8
Lung
0,5
0,2
0,5
0,8
0,7
Hema
4,7
5,9
2,1
2,0
1,0
1,9
Onk
1,7
3,9
2,6
1,7
3,1
2,7
Uro
0,2
0,2
0,9
0,5
Kir
2,2
2,8
5,4
1,5
0,6
1,3
Ort
0,2
0,7
0,5
0,5
0,6
0,6
Rygg
0,5
0,3
0,1
0,4
0,3
0,7
10,0
13,8
11,8
7,1
6,4
8,1
HPK
8,2
1,9
4,8
2,1
3,2
2,9
Ögon
0,4
0,4
0,3
0,4
0,4
Öron
2,8
0,3
3,0
5,0
0,7
0,3
NK
7,8
9,4
9,0
8,1
6,1
7,1
Rehab
0,5
0,9
0,7
0,1
3,5
3,5
19,7
12,5
17,9
15,6
13,9
14,2
Division CKOC
Division SC
0,8
Med akut
18
2011
1,7
0,2
MSEK
0,1
Neurol
2,9
2,9
2,3
0,5
1,2
3,3
Division NSC
2,9
2,9
2,3
0,6
1,2
3,3
41,3
39,2
48,7
30,8
31,7
32,2
Sum
Costs related to quality
Costs/DRG
(SEK)
19
Complication rate
(%)
(#6)