Spanish Hospital Cost Network Database: building a national benchmark from cost accounting practices

Abstract

Background Crucial input for a wide range of healthcare management decisions is cost information: pricing services, benchmarking etc., as well as the economic evaluation of health technologies and policies all require accurate cost data and exactly where to find such cost information remains a critical issue. The aim of this article is to describe the Spanish Hospital Cost Network Database characteristics and the underlying cost accounting criteria. Construction and content The database includes episode-level cost information from of 34 Spanish hospitals, representing 11% of the Spanish National Health System in 2021 (n = 4,788,080 episodes collected since the creation of the network in 2008). Each episode is described according to a vector containing clinical variables, administrative variables and cost components. Key assumptions include full costs, combination of top-down and bottom-up microcosting and Time-Driven Activity-Based Cost allocation. Utility and discussion The main output of the RECH dataset is the distribution of costs for a previously userdefined episode of care. Cost statistics, length of stay statistics and the detail of cost components are presented for six example episodes: Breast cancer surgery, Child delivery, Coronary artery bypass, Covid-19, Hip replacement and Inguinal hernia surgery. The fundamental methodological assumptions of the Spanish Hospital Cost Network Database are consistent with those from the HealthBASKET and EuroDRG projects. The results of the dataset are freely available. Conclusions The need to improve cost information is well defended from different perspectives in the literature. Throughout this work we have presented the methodologies underpinning the RECH project