Using Time-Driven Activity-Based Costing to establish a tariff system for home health care services

The most important societal challenge is aging, often associated with chronic disease and increased multimorbidity; nevertheless, the prospective cost of an aging society will not be sustainable in terms of health care and social services. In late 2011, the Campania Regional Government launched a study with the aim of implementing a tariff system for the provision of home and palliative care services. To define the tariff system, the regional government set up two working groups: one to identify home and palliative care profiles and the other to propose a tariff system for home and palliative care based on the profiles identified. The second group analyzed the average resources absorbed by each of the care profiles identified using a Time-Driven Activity-Based Costing system. The study carried out has two distinguishing features: a) its use to establish a system of tariffs related to services provided over a particular time frame set out in an Individualized Care Plan, and b) the method of calculating the daily cost of care, i.e. the cost of a “standard” day, including access to all the healthcare professionals, albeit with different weighting, required to care for the patient at home. The study identified a prospective tariff system based on the average total resources absorbed according to the different levels of patient complexity rather than historical costs, that, although it refers to a Italian regional context, it highlights a methodology that can be applied in other countries.