Developments in health care costing Philip Jacobs University of Alberta 1

1996 2

Response to wide variation in costing methods in published Canadian economic evaluations 3

Brought together diverse components of health care Inpatient Outpatient Physician services Drugs 4

Twenty years later…2016 Methods in health care costing still varied 5

Changes in the health care system since 1996 System organization - Individual units  Regions ALC days increasingly recognized Ambulatory care increase Regional administration Physician alternative payment Multi disciplinary clinics in physician practices Telemedicine 6

More changes to health care system Pharmaceuticals Product listing agreements Personalized medicine Non-physician professionals Increase in attention paid to public health and mental health Home care 7

Health care costing innovations Management information system and patient costing Alternative level of care (pre – discharge) CMG+, wider use of co-morbidities Canadian ambulatory care system Shadow billing Long term care 8

Costing guidance recognizes costing innovations 9

Gaps in costing Post acute care discharge / continuing / community care Home care Long term care Pharmaceuticals Product listing agreements Alternative providers Health care teams Mental health Public health Residential services (Buildings, furnishings) 10

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Conclusions Changes since 1996 necessitated new guidance document Guidance document 2 covers changes in costing Health system has changed considerably since 1996 Gaps remain in costing 12