Background: Diagnosis-related group (DRG)-based hospital payment systems have gradually become the principal means of reimbursing hospitals in many European countries. Owing to the absence or inaccuracy of costs related to DRGs, these countries have started to routinely collect cost accounting data. The aim of the present article was to compare the cost accounting systems of 12 European countries. Methods: A standardized questionnaire was developed to guide comprehensive cost accounting system descriptions for each of the 12 participating countries. Results: The cost accounting systems of European countries vary widely by the share of hospital costs reimbursed through DRG payment, the presence of mandatory cost accounting and/or costing guidelines, the share of cost collecting hospitals, costing methods and data checks on reported cost data. Each of these aspects entails a tradeoff between accuracy of the cost data and feasibility constraints. Conclusion: Although a ‘best’ cost accounting system does not exist, our cross-country comparison gives insight into international differences and may help regulatory authorities and hospital managers to identify and improve areas of weakness in their cost accounting systems. Moreover, it may help health policymakers to underpin the development of a cost accounting system.

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Keywords health care, diagnosis-related group, cost accounting systems
Persistent URL dx.doi.org/10.1093/eurpub/cku025, hdl.handle.net/1765/77071
Journal European Journal of Public Health
Grant This work was funded by the European Commission 7th Framework Programme; grant id fp7/223300 - EuroDRG – Diagnosis-Related Groups in Europe: towards Efficiency and Quality (EURODRG)
Tan, S.S, Geissler, A, Serdén, L, Heurgren, M, van Ineveld, B.M, Redekop, W.K, & van Hakkaart-van Roijen, L. (2014). DRG systems in Europe: variations in cost accounting systems among 12 countries. European Journal of Public Health, 1–6. doi:10.1093/eurpub/cku025