Measuring End-of-Life Healthcare Costs in Complex Systems

1. COST ACCOUNTING WORKGROUP(members=health economists, health policy and clinician researchers, EOL Care Project PI’s) Stephen F. Seninger, Ph.D. Workgroup Chair

2. The Problem • How to accurately measure End-of-Life health care costs • Within a complex, multi-sector health care ‘system’ • Where methods of ‘cost’ measurement vary depending on:: institutional environment, type of insurance, & reimbursement system RWJ Cost Accounting Workgroup-February 2002

3. Figure 1. Real & Observed Costs for End-of-Life Care Regional Variations In Costs Observed $Costs Overhead and non-service Costs Cost Shifting & Monopoly Profits Health Care Resources Real Costs= Opportunity $Costs RWJ Cost Accounting Workgroup-February 2002

4. The Need • Will improvements in care of dying save health care system money? • Does good End of Life Care Cost More or Less? RWJ Cost Accounting Workgroup-February 2002

5. Solutions & First Steps • Identify methods and develop measurement tools for micro-costing • Show how methods vary over different institutional environments • Develop a data base and compendium of existing tools and disseminate information RWJ Cost Accounting Workgroup-February 2002

6. Figure 2. Applied View of Health Care Production • Nursing Care • Tests • Laboratory/ X-ray • Medical Social Work • Physician Services • Counseling • Home Care • Inpatient Care • Outpatient Care • Respite Care • Medication • Therapy • Bereavement Services • Family /Personal Caregiving Labor Supplies • Palliative Care • Hospice Equipment Resources/Inputs Final Products Medical Technology Intermediate Products RWJ Cost Accounting Workgroup-February 2002

7. Products • Position Paper in Spring, 2002 • Applied Practicum on Costing Methods for End of Life Healthcarewith case examples • References on cost data sources • Web Site & information from NPO RWJ Cost Accounting Workgroup-February 2002