Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal

Funding Information: Hugo F. Mendonça Vitor G. Vicente Publisher Copyright: © 2023, The Author(s).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.publishersversionpublishe

Aplicação da metodologia Time-Driven Activity-Based Costing a um programa de gestão de caso de doentes complexos, em contexto de Unidades Locais de Saúde

RESUMO - O número de pessoas com doenças crónicas tem aumentado globalmente, assim como o número de doenças crónicas por pessoa. Perante esta realidade, o termo “doente complexo” é cada vez mais atual. Os custos de cuidados de saúde associados a estes doentes são altos e têm previsão de aumento, uma vez que, os sistemas de saúde não estão ainda, na sua maioria, preparados para a prestação de cuidados integrados de longa duração. Em Portugal, várias são as instituições de saúde que têm desenvolvido esforços para prestar cuidados integrados: os modelos de gestão de caso têm sido implementados para acompanhamento de doentes complexos. Porém, estudos relativos ao apuramento de custos destes programas são, ainda, limitados. Na presente investigação foram apurados os custos diretos da prestação de cuidados a um doente complexo envolvido num programa de gestão de caso, fazendo uso da metodologia Time-Driven Activity-Based Costing. Para tal, desenhou-se um mapa do processo do doente complexo, considerando um percurso standard no programa. Às atividades do mapa foram alocados tempos e custos, de acordo com práticas portuguesas e internacionais de modelos de gestão de caso. Obtiveram-se os tempos gastos pelos profissionais e recursos envolvidos e os custos associados a cada doente. Não foi estudado o impacto económico das atividades analisadas porém, segundo autores internacionais, quando bem aplicados e selecionados, os modelos de cuidados integrados levam à redução de custos e melhoria dos resultados em saúde.ABSTRACT - The number of people with chronic diseases is increasing globally, as is the number of chronic diseases themselves per person. Given this reality, the term “complex patient” is increasingly current. The healthcare costs associated with these patients are high and are expected to increase since health systems are not yet prepared for integrated long-term care. In Portugal, several health institutions have made efforts to provide integrated care. Case management models have been implemented for complex patients. However, no study has yet been carried out on the cost of these programs. In the present investigation, the direct costs of a complex patient involved in the standard flow of a case management program were determined, using Time-Driven Activity-Based Costing. Therefore, a route map of the complex patient was drawn in the standard flow of the program. Time and costs were allocated to the map activities, in accordance with Portuguese and international practices of case management models. The time spent by the professionals and resources involved and the costs associated with each patient were obtained. The economic impact of the activities analyzed was not studied, however, according to international authors, when well applied and selected, integrated care models lead to cost reduction and improvement in health outcomes

Designing an IT system for a Case Management Program

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