1. COST ACCOUNTING WORKGROUP (members=health economists, health policy and clinician researchers, EOL Care Project PI’s) Stephen F. Seninger, Ph.D. Workgroup Chair

2. RWJ Cost Accounting Workgroup- February 2002 The Problem How to accurately measure End-of-Life health care costs Within a complex, multi-sector health care ‘system’ Where methods of ‘cost’ measurement vary depending on:: institutional environment, type of insurance, & reimbursement system

3. RWJ Cost Accounting Workgroup- February 2002 Regional Variations In Costs Overhead and non-service Costs Cost Shifting & Monopoly Profits Health Care Resources Real Costs= Opportunity $Costs Figure 1. Real & Observed Costs for End-of-Life Care Observed $Costs

4. RWJ Cost Accounting Workgroup- February 2002 The Need Will improvements in care of dying save health care system money? Does good End of Life Care Cost More or Less?

5. RWJ Cost Accounting Workgroup- February 2002 Solutions & First Steps Identify methods and develop measurement tools for micro-costing Show how methods vary over different institutional environments Develop a data base and compendium of existing tools and disseminate information

6. RWJ Cost Accounting Workgroup- February 2002 Figure 2. Applied View of Health Care Production Labor Supplies Equipment Medical Technology Nursing Care Tests Laboratory/ X-ray Medical Social Work Physician Services Counseling Home Care Inpatient Care Outpatient Care Respite Care Medication Therapy Bereavement Services Family /Personal Caregiving Palliative Care Hospice Resources/Inputs Intermediate Products Final Products

7. RWJ Cost Accounting Workgroup- February 2002 Products Position Paper in Spring, 2002 Applied Practicum on Costing Methods for End of Life Healthcare  with case examples References on cost data sources Web Site & information from NPO