226 Chapter 8
CASE STUDY FOR CHAPTER 8
Estimating Hospitalization Costs for Regional Hospitals
Cost estimation and cost containment are an important concern for a wide range of for-profit and
not-for-profit organizations offering health-care services. For such organizations, the accurate
measurement of costs per patient day (a measure of output) is necessary for effective management.
Similarly, such cost estimates are of significant interest to public officials at the federal, state, and
local government levels. For example, many state Medicaid reimbursement programs base their
payment rates on historical accounting measures of average costs per unit of service. However,
As an alternative to accounting cost estimation methods, one might consider using
engineering techniques to estimate nursing costs. For example, the labor cost of each type of service
could be estimated as the product of an approximation of the time required to perform each service
times the estimated wage rate per unit of time. Multiplying this figure by an estimate of the
frequency of service gives an engineering estimate of the cost of the service. A possible limitation to
the accuracy of this engineering cost-estimation method is that treatment of a variety of illnesses
often requires a combination of nursing services. To the extent that multiple services can be
provided simultaneously, the engineering technique will tend to overstate actual costs unless the
effect of service “packaging” is allowed for.
Cost estimation is also possible by means of a carefully designed regression-based approach
using variable cost and service data collected at the ward, unit, or facility level. Weekly labor costs
Long-run costs per nursing facility can be estimated using either cross-section or time-series
methods. By relating total facility costs to the service levels provided by a number of hospitals,
nursing homes, or out-patient care facilities during a specific period, useful cross-section estimates