Time Driven Activity Based Costing (TDABC), cost calculation model adapted to chronic disease care pathway? Cases of stroke care pathway

Chronic diseases are the main item of health expenditure, they require a global and transversal support of the patient via the care pathway, while Diagnosis related groups based payment contributes to strengthening the divisions. An intervention research on a chronic disease pathway, the stroke, 3rd death cause in France, aims verifying the applicability of a cost-per-activity calculation such as Time Driven Activity Based Costing (TDABC). According to the criteria of simplicity and precision of cost evaluation methods, the literature suggests that a cost-per-activity calculation is adapted to the transversal approaches and to the health sector. The research findings limited to a part of the pathway show the applicability of the TDABC and the taking into account in the time equations of the costs variations linked to the pathways diversity and the treatment evolutions. Despite the method limitations (difficulty of estimating time and considering what is nonquantifiable as the cares value), the TDABC presents several contributions : possible simplification by the Pareto law, a tool that is understandable by health professionals and sparking dialogue, simulation of the « hidden costs » of resource unavailability and bottlenecks.