Getting costs down to patient level is complex for the same reason that finance and clinical departments have trouble communicating: a completely different approach is taken to the two sets of information that have to be used.
A cat’s cradle: illustration based on three main cost drivers, Medical, Nursing and Theatres, shows the mapping of ledger entries to clinical resources followed by allocation to patient records using appropriate weightings. Cost data takes the form of figures from the General Ledger associated with cost centres and subjective account codes. Some may match clinical categories, e.g. if a cost centre correspond to a specialty, while others may cut across clinical categories.
The first step in the Ardentia approach is to view costs as covering a series of components of care, resources such as ward nursing, diagnostic services, medical time, the different elements of theatre provision (nursing, surgeons, anaesthetists, consumables, premises), etc. The categories used should correspond to the cost buckets used for reference costing.