Costing Psychiatric Hospitals and Psychiatric Wards in General Hospitals

Abstract

Costing psychiatric hospitals was initially the main interest of accountants and hospital managers because it targets cost-saving issues. Health Economics emerged while psychiatric deinstitutionalization was in progress, shifting from hospitals to a community mental healthcare model. This triggered multiple studies comparing costs between hospitals and community services. However, methods for estimating psychiatric hospital costs have been rarely described in these studies. A top-down approach has been the method most used for estimating costs in psychiatric hospitals, because many of these costing exercises are aimed accounting goals. On the other hand, with the emergence of Health Economics, allowing the comparison of costs and benefits among multiple models of care, a bottom-up approach became the most recommended method for costing services because individual variations in costs depend on the user’s profile and other factors. There are three main categories for estimating hospital costs: capital costs (including land, buildings, and equipment), “hotel” costs (support services, overhead, consumables, and human resources), and treatment costs (clinical staff, medication, laboratory tests, and imaging). The first step is to accurately describe the hospital in order to identify components of costs and to decide how data will be collected. Estimating a unit costs might be complex in some activities that share costs or in joint production costs because professionals can work in more than one ward. Double counting should be carefully avoided. This chapter ends with an example of costing psychiatric hospitals in Brazil using top-down and bottom-up approaches.