The
Veterans Affairs health care system has long experimented
with methods of novel cost monitoring,18 yet still uses traditional
costing at the department level with a slightly more
detailed system that allocates costs by DRG, length of stay,
and bed-section. ABC at the Veteran Affairs (VA) is generally
only used for research, where it is popular for evaluating
cost-effectiveness of new interventions. The fact that detailed
costing systems are not more common in health care suggests
that crossover from manufacturing is challenging.
Difficulties arise in the scalability of detailed costing models,
particularly as different patients in the same production
process may accumulate additional costs of comorbidities
and complications.