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

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...

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Autores principales: Ortet, Yasmara, Seringa, Joana, Santana, Rui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10347829/
https://www.ncbi.nlm.nih.gov/pubmed/37443013
http://dx.doi.org/10.1186/s12913-023-09729-5
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author Ortet, Yasmara
Seringa, Joana
Santana, Rui
author_facet Ortet, Yasmara
Seringa, Joana
Santana, Rui
author_sort Ortet, Yasmara
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09729-5.
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spelling pubmed-103478292023-07-15 Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal Ortet, Yasmara Seringa, Joana Santana, Rui BMC Health Serv Res Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09729-5. BioMed Central 2023-07-13 /pmc/articles/PMC10347829/ /pubmed/37443013 http://dx.doi.org/10.1186/s12913-023-09729-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Ortet, Yasmara
Seringa, Joana
Santana, Rui
Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal
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 Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10347829/
https://www.ncbi.nlm.nih.gov/pubmed/37443013
http://dx.doi.org/10.1186/s12913-023-09729-5
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