Analysing home-care services costing by microcosting: A scoping review

Abstract

AbstractObjectiveto map models of Home Care services in the world and the costs associated with them.MethodScope review developed in five stages: identification of the research question; identification of relevant studies; selection of studies; analysis, grouping, synthesis and presentation of data. The search was carried out in seven scientific databases and the gray literature was searched. Texts were included containing a description of the Home Care model/service addressing measures, analyzes or cost comparison, as well as components and cost calculation methods. The texts found were evaluated by two independent researchers for judgment on inclusion. Forty articles that addressed service models and their costs were included and analyzed in depth, in this publication, the eight articles referring to the micro-costing method for calculating costs.ResultThe eight articles, which deal with the micro-costing method in calculating the costs of home care services, were published between 1997 and 2005, one in Spanish and seven in English. The texts deal with two service models: Hospital-at-Home and Home Visit Care. The direct cost components considered were: personnel, medication, inputs, diagnostic and therapeutic tests, transport, equipment depreciation; health care and support services. As indirect and fixed costs, the following were identified: general maintenance, management and administration, hospitality, inpatient units, archives and others, according to hospital cost accounting data. The studies adopt the benchmarks of cost-effectiveness or cost-minimization for economic evaluation. For the cost analysis, the concepts of cost savings and the difference between average cost and cost are used marginally.Conclusionthe concepts of health care costs were mostly approached from the accounting-financial perspective, with calculation of direct, variable or fixed costs. The economic or indirect costs related to the opportunity for HC, costs of family members who care for patients, absenteeism and loss of productivity due to illness are rare and partial in the studies included. This analysis reinforces the need to recognize costs as metadata in the management of health organizations, which means that cost information carries other information.