Improving healthcare performance has become a need for resource optimisation in a field where they are scarce. Activity‐Based Costing (ABC) has been applied for more than 30 years to allocate costs ...and provide information for decision‐making. This paper seeks to review previous literature in the health field that analysed this cost system and its new version, TDABC (Time‐Driven Activity‐Based Costing). Five hundred ninety articles published from 1989 to 2019 were retrieved from Scopus and Medline. The review includes descriptive, relational and content analyses. Results show that the interest in applying these cost systems is growing, especially in journals focusing on the financial aspects of health, policy and planning, and radiology. However, there is a difference in the application of ABC and TDABC. ABC is more related to efficiency and more used in laboratories. In contrast, TDABC is primarily used in hospitals and addressing the value of health rather than cost‐effectiveness. On the other hand, the findings suggest that TDABC present greater opportunities for publication compared with ABC. Its progression is higher and gets more citations. The current article contributes to broadening the field's vision and encourages authors for further research.
Implementation of value-based initiatives depends on cost-assessment methods that can provide high-quality cost information. Time-driven activity-based costing (TDABC) is increasingly being used to ...solve the cost-information gap. This study aimed to review the use of the TDABC methodology in real-world settings and to estimate its impact on the value-based healthcare concept for inpatient management.
This systematic review was conducted by screening PubMed/MEDLINE and Scopus databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including all studies up to August 2019. The use of TDABC for inpatient management was the main eligibility criterion. A qualitative approach was used to analyze the different methodological aspects of TDABC and its effective contribution to the implementation of value-based initiatives.
A total of 1066 studies were retrieved, and 26 full-text articles were selected for review. Only studies focused on surgical inpatient conditions were identified. Most of the studies reported the types of activities on a macrolevel. Professional and structural cost variables were usually assessed. Eighteen studies reported that TDABC contributed to value-based initiatives, especially cost-saving findings. TDABC was satisfactorily applied to achieve value-based contributions in all the studies that used the method for this purpose.
TDABC could be a strategy for increasing cost accuracy in real-world settings, and the method could help in the transition from fee-for-service to value-based systems. The results could provide a clearer idea of the costs, help with resource allocation and waste reduction, and might support clinicians and managers in increasing value in a more accurate and transparent way.
•The greatest contributions to value-based initiatives achieved by the use of time-driven activity-based costing (TDABC) are care-cycle optimization throughout the care trajectory and the identification of care benchmarks that can facilitate health system improvement opportunities.•TDABC could be a strategy to increase cost accuracy in real-world settings, and it could help in the transition from fee-for-service to value-based systems through its capability to contribute to cost savings.•In a healthcare system that is continually marked by extensive waste, the application of innovative methods that contribute to the redesign of healthcare services delivery to make them more effective is necessary.•The health system can benefit from using cost management methods such as TDABC, because opportunities to facilitate patients’ access to the healthcare system are more effectively and safely achieved through the redesign of patients’ course of care trajectory.
Highlights • TDABC helps to address the challenge of costing conditions in health care. • TDABC applications varied but generally reflected the seven-step model. • Future TDABC Applications should ...consider the methodological recommendations in this review. • TDABC is yet to overcome challenges with allocating support department costs. • TDABC’s ability to inform bundled payment reimbursement is not well established.
To determine a product mix for a production process, this study proposes a mixed-integer programming (MIP) model, based on the time-driven activity-based costing (TDABC) accounting system. By using a ...time driver from the resource to the cost objects and simultaneously dealing with numerous resource limitations, the model obtains a global optimal decision. The model highlights the difference between supply and the use of the capacity. It avoids some possible limitations of the programming modeling approach when theory of constraints (TOC) or activity-based-costing (ABC) is used. The model is illustrated using a numerical example. In the form of a budgeted income statement, the results for the formulated MIP models that use TOC, ABC and TDABC are compared, in terms of resource-used-based profit, resource-supplied-based profit and cash flow. The proposed MIP model that uses TDABC is shown to support a product mix decision, on which studies of TDABC seldom focus. Implications for the use of this accounting system adoption to determine product-mix are detailed.
Implementation strategies increase the adoption of evidence-based practices, but they require resources. Although information about implementation costs is critical for decision-makers with budget ...constraints, cost information is not typically reported in the literature. This is at least partly due to a need for clearly defined, standardized costing methods that can be integrated into implementation effectiveness evaluation efforts.
We present a pragmatic approach to systematically estimating detailed, specific resource use and costs of implementation strategies that combine time-driven activity-based costing (TDABC), a business accounting method based on process mapping and known for its practicality, with a leading implementation science framework developed by Proctor and colleagues, which guides specification and reporting of implementation strategies. We illustrate the application of this method using a case study with synthetic data.
This step-by-step method produces a clear map of the implementation process by specifying the names, actions, actors, and temporality of each implementation strategy; determining the frequency and duration of each action associated with individual strategies; and assigning a dollar value to the resources that each action consumes. The method provides transparent and granular cost estimation, allowing a cost comparison of different implementation strategies. The resulting data allow researchers and stakeholders to understand how specific components of an implementation strategy influence its overall cost.
TDABC can serve as a pragmatic method for estimating resource use and costs associated with distinct implementation strategies and their individual components. Our use of the Proctor framework for the process mapping stage of the TDABC provides a way to incorporate cost estimation into implementation evaluation and may reduce the burden associated with economic evaluations in implementation science.
Objective
Traditional hospital accounting fails to provide an accurate cost of complex surgical care. Here we describe the application of time‐driven activity‐based costing (TDABC) to characterize ...costs of head and neck oncologic procedures involving free tissue transfer.
Study Design
Retrospective cohort study.
Setting
Single tertiary academic medical center.
Methods
An analysis of head and neck oncologic procedures involving microvascular free flap reconstruction from 2018 to 2020 (n = 485) was performed using TDABC methodology to measure cost across operative case and postoperative admission, using quantity of time and cost per unit of each resource to characterize resource utilization. Univariate and generalized linear mixed models were used to examine associations between patient and hospital characteristics and cost of care delivery.
Results
The total cost of care delivery was $41,905.77 ± 21,870.27 with operating room (OR) supplies accounting for only 10% of the total cost. Multivariable analyses identified significant cost drivers including operative time, postoperative length of stay, number of return trips to the OR, postoperative complication, number of free flaps performed, and patient transfer from another hospital or via emergency department admission (P < .05).
Conclusion
Operative time and postoperative length of stay, but not operative supplies, were primary drivers of cost of care for head and neck oncology cases involving free tissue transfer. TDABC offers granular cost characterization to inform cost optimization through unused capacity identification and postoperative admission efficiencies.
Objetivo: Analisar o nível de transparência nos sites de municípios paraibanos de diferentes portes numa perspectiva longitudinal. Metodologia: Foram selecionados 20 municípios, de acordo com o ...porte, para compor uma amostra aleatória estratificada, sendo coletados, em 2019 e em 2023, dados dos seus sites a fim de calcular um índice de transparência formado pelos temas: conteúdo, série histórica e usabilidade. Foi feita a estatística descritiva dos indicadores. Foram elaborados rankings de transparência. Foram feitos testes de correlação entre porte e transparência. Foi empregado o teste t de student para verificar se em média houve variação nos indicadores de transparência entre 2019 e 2023. Resultados: O índice de transparência e a usabilidade tiveram correlação positiva e moderada com o porte em 2019 e em 2023, ao passo que as correlações deste com o conteúdo e a série histórica tiveram pouca ou nenhuma significância estatística. Por sua vez, a usabilidade e o conteúdo tiveram correlação positiva e moderada de maneira consistente nos dois anos. De modo geral, os municípios melhoraram o nível de transparência e seus indicadores são apenas parcialmente associados ao porte. João Pessoa e Campina Grande, os maiores municípios, tiveram boas colocações tanto em 2019, quanto em 2023, mas municípios menores, como Sapé e Uiraúna, também tiveram boas colocações nos dois rankings. Contribuições do Estudo: A análise longitudinal é uma contribuição à literatura nacional. A usabilidade foi identificada como elemento impulsionador da transparência. Contribui-se com o desenho da política de transparência no Brasil apontando a necessidade de se fornecer suporte técnico aos pequenos e médios municípios. A revisão da literatura identificou novos paradigmas ainda não abordados nas pesquisas nacionais: a teoria das janelas e os princípios de design. A interpretação dos resultados proporcionou um diálogo entre abordagens teóricas e conceituais tratadas de maneira separada em outros estudos de transparência.
The purpose of this Special Issue is to investigate topics related to sustainability issues in the new era, especially in Industry 4.0 or other new manufacturing environments. Under Industry 4.0, ...there have been great changes with respect to production processes, production planning and control, quality assurance, internal control, cost determination, and other management issues. Moreover, it is expected that Industry 4.0 can create positive sustainability impacts along the whole value chain. There are three pillars of sustainability, including environmental sustainability, economic sustainability, and social sustainability. This Special Issue collects 15 sustainability-related papers from various industries that use various methods or models, such as mathematical programming, activity-based costing (ABC), material flow cost accounting, fuel consumption model, artificial intelligence (AI)-based fusion model, multi-attribute decision model (MADM), and so on. These papers are related to carbon emissions, carbon tax, Industry 4.0, economic sustainability, corporate social responsibility (CSR), etc. The research objects come from China, Taiwan, Thailand, Oman, Cyprus, Germany, Austria, and Portugal. Although the research presented in this Special Issue is not exhaustive, this Special Issue provides abundant, significant research related to environmental, economic, and social sustainability. Nevertheless, there still are many research topics that require our attention to solve problems of sustainability.
Objectives/Hypothesis
Providing high‐value healthcare to patients is increasingly becoming an objective for providers including those at multidisciplinary aerodigestive centers. Measuring value has ...two components: 1) identify relevant health outcomes and 2) determine relevant treatment costs. Via their inherent structure, multidisciplinary care units consolidate care for complex patients. However, their potential impact on decreasing healthcare costs is less clear. The goal of this study was to estimate the potential cost savings of treating patients with laryngeal clefts at multidisciplinary aerodigestive centers.
Study Design
Retrospective chart review.
Methods
Time‐driven activity‐based costing was used to estimate the cost of care for patients with laryngeal cleft seen between 2008 and 2013 at the Massachusetts Eye and Ear Infirmary Pediatric Aerodigestive Center. Retrospective chart review was performed to identify clinic utilization by patients as well as patient diet outcomes after treatment. Patients were stratified into neurologically complex and neurologically noncomplex groups.
Results
The cost of care for patients requiring surgical intervention was five and three times as expensive of the cost of care for patients not requiring surgery for neurologically noncomplex and complex patients, respectively. Following treatment, 50% and 55% of complex and noncomplex patients returned to normal diet, whereas 83% and 87% of patients experienced improved diets, respectively. Additionally, multidisciplinary team‐based care for children with laryngeal clefts potentially achieves 20% to 40% cost savings.
Conclusions
These findings demonstrate how time‐driven activity‐based costing can be used to estimate and compare patient costs in multidisciplinary aerodigestive centers.
Level of Evidence
2c. Laryngoscope, 127:2152–2158, 2017
Every enterprise seeks to determine as accurately as possible the cost of the products or services it produces. The allocation of indirect costs causes considerable difficulties in this process. In ...the search for the most accurate alternatives for allocating indirect costs, the Activity Based Costing (ABC) method has become more popular in recent decades and is increasingly used by companies. The ABC method has many advantages, but it also has disadvantages, which have led to further development of the method by proposing newer versions. These include Fuzzy Activity Based Costing (FABC), which reduces the risk of uncertainty in data collection conditions and inaccurate cost allocation. However, while the literature provides a theoretical model of the FABC approach, there is very little research focused on sector-specific companies. Given that the issue of indirect cost allocation is particularly relevant for manufacturing companies, this paper explores the possibilities of applying the FABC method in manufacturing companies, using the example of a paper and cardboard manufacturing company. The aim of the research: after revealing the principles of ABC and FABC implementation, to improve the indirect cost allocation process in a paper and cardboard manufacturing company using the FABC method. The methods used for the study were document analysis, observation, conversation, interview, and fuzzy set analysis. The results showed that the FABC method has lower cost drivers for some activities and higher cost drivers for others than the ABC method. The improvement path developed for the allocation of indirect costs using the FABC approach could serve as a good model for its implementation in other manufacturing sectors.
Kiekviena įmonė siekia kuo tiksliau nustatyti gaminamos produkcijos ar teikiamų paslaugų savikainą. Šiame procese nemažai sunkumų sukelia netiesioginių išlaidų paskirstymas. Ieškant kuo tikslesnių netiesioginių išlaidų paskirstymo alternatyvų, pastaraisiais dešimtmečiais išpopuliarėjo ir įmonėse vis plačiau taikomas veikla grįstas produkcijos savikainos kalkuliavimo metodas (angl. Activity Based Costing, sutr. ABC). ABC metodas turi daug privalumų, tačiau jam būdingi ir trūkumai, kurie lėmė tolesnį metodo tobulinimą, pasiūlant naujesnes metodo versijas. Tarp jų, neraiškųjį veikla grįstą produkcijos savikainos kalkuliavimą (angl. Fuzzy Activity Based Costing, sutr. FABC), kuris leidžia sumažinti riziką dėl duomenų rinkimo sąlygų neapibrėžtumo ir netikslaus išlaidų paskirstymo. Vis dėlto, nors mokslinėje literatūroje ir pateiktas teorinis FABC metodo modelis, tačiau taikomųjų tyrimų, skirtų konkretaus sektoriaus įmonėms, yra labai mažai. Atsižvelgiant į tai, kad netiesioginių išlaidų paskirstymo problema ypatingai aktuali gamybos įmonėms, straipsnyje nagrinėjamos FABC metodo taikymo galimybės gamybos įmonėse popieriaus ir kartono gaminių gamybos įmonės pavyzdžiu. Tyrimo tikslas: atskleidus ABC ir FABC diegimo principus, patobulinti netiesioginių išlaidų paskirstymo eigą popieriaus ir kartono gaminių gamybos įmonėje, naudojant FABC metodą. Tyrimui atlikti naudoti dokumentų analizės, stebėjimo, pokalbio, interviu, neraiškiųjų aibių analizės metodai. Tyrimo rezultatai atskleidė, kad naudojant FABC metodą dalies veiklos sričių išlaidų koeficientai yra mažesni, o dalies didesni negu naudojant ABC metodą. Parengta netiesioginių išlaidų paskirstymo tobulinimo eiga, naudojant FABC metodą, galėtų būti tinkamu pavyzdžiu diegiant jį ir kitų gamybos sektorių įmonėse.
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