Traditional cost accounting systems accumulate either actual
direct costs (job-order costing) or standardized direct costs
(standard costing) for each product. In the health care setting,
the “product” is patient health. Allocating direct costs is not
particularly difficult; one simply sums the costs easily
tracked to an individual, such as medications, patient supplies,
and surgical equipment. It is the allocation of indirect
costs that can prove troublesome. This is generally accomplished
by allocating a portion of indirect overhead costs,
such as general administrative costs, to each job based on a
pre-selected method of allocation. The hourly rate method is
such an example, in which a predetermined hourly overhead
rate for a particular service is allocated to the patient based
on length of time the service is used. Another method uses a
predetermined daily overhead rate, in which overhead is
allocated to patients based on the length of the hospital stay.
A third method can be called the “mark-up” method, in
which a preset percentage of the patient’s direct costs are
added to the bill to represent overhead. Although convenient,
these methods are known to over-allocate overhead to routine
high-volume services, and under-allocate overhead to
low-volume services. When the cost of services varies significantly,
as occurs in many organizations, these misallocations
can be quite significant. Overpricing affects the ability
to compete in the marketplace, and underpricing affects
profitability.