Cost accounting models used for price-setting of health services: An international review

- I present different cost accounting models which are used for cost-based pricing of health services.
- I compare models from fourteen countries and systematize them in terms of how cost accounting process is organized.
- The most sophisticated bottom-up microcosting models are used in Australia, Germany and Sweden.
- The more sophisticated the costing model, the more complex the information system at the hospital is needed.
- Other important aspects are the selection of sample hospitals and the verification process.

The aim of the article was to present and compare cost accounting models which are used in the area of healthcare for pricing purposes in different countries. Cost information generated by hospitals is further used by regulatory bodies for setting or updating prices of public health services. The article presents a set of examples from different countries of the European Union, Australia and the United States and concentrates on DRG-based payment systems as they primarily use cost information for pricing.Differences between countries concern the methodology used, as well as the data collection process and the scope of the regulations on cost accounting. The article indicates that the accuracy of the calculation is only one of the factors that determine the choice of the cost accounting methodology. Important aspects are also the selection of the reference hospitals, precise and detailed regulations and the existence of complex healthcare information systems in hospitals.