Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level

• Published in: Health policy (Amsterdam) Vol. 122; no. 4; pp. 396 - 403
• Main Authors: García-Cornejo, Beatriz, Pérez-Méndez, José A.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-04-2018; Elsevier Science Ltd
• Subjects: Cost accounting; Cost accounting systems; Cost control; Financial performance; Health administration; Health authorities; Health care expenditures; Health care policy; Health services; High technology; High-cost; Hospital costs; Hospitals; Implementation; Management information systems; Medical technology; Medical treatment; Patients; Policy making; Public enterprise; Public hospitals; Technology; Hospital costs; Technology; High-cost; Management information systems; Cost accounting systems; Public hospitals; Cost control
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2018.01.013

•We analyse the determinants of variation in the cost of hospital stays.•We study the effect of standardized cost systems on cost containment in hospitals with different technological levels.•We use the data from 242 hospitals of Spanish National Health Service between 2010 and 2013.•Advanced cost systems contribute to cost savings but to a lesser extent in high-tech hospitals.
Promoting the improvement of standardized cost systems (CS) is one of the measures available to health policy makers for the purpose of improving efficiency in hospitals over the long-term. Nevertheless, very few studies evaluate the relationship between alternative CS and the costs really incurred. We use data from 242 hospitals of the Spanish National Health Service (NHS) between 2010 and 2013 in order to explore the determinants of the cost per adjusted patient day, using a difference-in-differences approach where the treatment is the implementation of an advanced CS. We also investigate if the association between advanced CS and unit cost is different depending upon the technological level of the hospital. Results show that hospitals with more advanced CS contained their costs better. However, the latter effect of advanced CS is lower in hospitals with a greater endowment of high technology. Results suggest that health authorities should support the development of CS, particularly in high-tech hospitals, which are usually larger and more complex hospitals that tend to accumulate a greater portion of NHS hospital sector expenditure.