Impact of Cost Accounting Models on Estimations in Adult Intensive Care Units (ICUs) and on Reimbursement System: A Case Study of a Public Hospital During the Covid-19 Pandemic

The aim of the present study is to estimate the real cost of an adult intensive care unit (ICU) and to compare it, initially, with the cost calculated by the hospital, according to the cost accounting model that it currently applies, and following, with the corresponding reimbursement, received by the National Organization for Health Care Services (EOPYY) in order to identify any discrepancies between the real cost and reimbursement. The comparison of the data covered the years 2019–2021, in order to investigate also the impact of the Covid-19 pandemic on ICU costs. Quantitative data were collected, and the top-down accounting microcosting method was used to calculate costs. The analysis of the cost data revealed that the actual cost, in 2019, was greater than what the hospital calculated, a fact that, according to the research, led also to a much lower reimbursement. However, the discrepancy was even greater in the following two years, where the emergence of Covid-19 exploded the need for ICU hospitalization. Moreover, the daily reimbursement of hospital was not adjusted in line with the increase in costs, with the result that in the years 2019–2021, the reimbursement was by 18.20% less than the real cost of the ICU. In order to avoid this phenomenon, the study concludes that Greek public hospitals should adopt a reliable accounting costing system, which will have the capacity to monitor in real time all changes in costing data, with which its reimbursement will be linked.