Custeio de procedimentos hospitalares na rede pública de Belo Horizonte: aplicação do Método Time-driven Activity-based Costing

Abstract

Introduction: Value in medicine is determined by important patient outcomes and its associated costs. However, measuring healthcare costs is challenging. Without an adequate understanding of its formation, it is not possible establish with assertiveness which interventions will be able to control costs and which measures will result in greater value delivered to patients. Although several costing methods have been traditionally applied in healthcare system, more accurate methodologies, based on resources consumed in care process, are necessary for a better understanding and control of expenses and, consequently, for a better standard of care. This work presents Time-Driven Activity-Based Costing (TDABC) application in Brazilian public hospitals, aiming to contribute to healthcare services management and value-based healthcare initiatives. Objectives: Estimate cost of two hospital procedures, therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) and Stroke hospitalization, using TDABC, in public hospitals located in the city of Belo Horizonte, identifying potential benefits and main difficulties faced during this process. Methods: A research was conducted with a quantitative approach, using an exploratory case study methodology, presented as two scientific articles. Data collection was obtained through consultations with medical records, hospital data systems and interviews. Application of TDABC followed steps established in literature. Results: Estimated average cost of therapeutic ERCP was BRL 4.788,18 while that for stroke hospitalization was R$ 7.067,50. Discussion: Even considering the difficulties faced in TDABC application, this method allows a better understanding of costs formation and an improved view of healthcare processes. This study lays foundations for enabling hospitals and other healthcare providers to incorporate financial analysis in development of evidence for decision-making, contributing to awareness of economic assessments importance in healthcare services routines. Conclusions: TDABC approach has brought to light a set of core capabilities that can be prioritized in future quality improvement and cost control efforts. Through these essential capabilities, healthcare services will be able to make better decisions aimed at delivering value to patients, which can serve as an incentive for organizational and care improvements. Future studies, aggregating outcome assessments, may, even more plainly, clarify financial needs for healthcare managers and policymakers, who, in turn, must realize that evidence-based investments will result in greater aggregated benefits to the whole healthcare system.