1. Developments in health care costing Philip Jacobs University of Alberta 1

2. 1996 2

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

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

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

6. 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

7. 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

8. 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

9. Costing guidance recognizes costing innovations 9

10. 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

11. 11

12. 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