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Patient-Based Costing, DRGs, EHR Design, Process Mining, and Clinical Terminologies in Acute Hospitals

Abstract In an acute hospital, Diagnosis-Related Groups (DRGs) and patient-based costing solve different, complementary problems. DRGs are a prospective payment and case-mix classification mechanism : they group inpatient episodes for reimbursement and resource allocation using coded diagnoses, procedures, severity, and other episode variables. Patient-based costing - especially Activity-Based Costing (ABC) and Time-Driven Activity-Based Costing (TDABC) - is an internal measurement method : it estimates the actual resources consumed by a given patient across the care cycle. The practical implication is that DRGs tell the hospital what it is likely to be paid, while patient-based costing tells the hospital what the case actually cost. An effective acute-hospital costing architecture therefore requires structured EHR data, reliable timestamps and event logs, linkage to HR/finance/supply systems, and a semantic layer that uses SNOMED CT and LOINC for point-of-care capture and WHO ICD-11 a...
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Patient-Based Costing in Belgian Hospitals: Building ABC and TDABC from MZG/RHM and FINHOSTA - To Be

Introduction Patient-based costing seeks to measure the cost of care at the level of the individual patient rather than by broad departmental or specialty averages. In methodological terms, activity-based costing (ABC) assigns costs to activities and then to cost objects through cost drivers, whereas time-driven activity-based costing (TDABC) simplifies this logic by combining two core parameters: the cost of supplying resource capacity and the time required to perform the activities in the care process. In healthcare, TDABC has become especially relevant because it is explicitly tied to process mapping and the measurement of real care delivery across pathways. For Belgian hospitals, the policy relevance of patient-level costing is unusually high. Belgium still allocates a major part of hospital financing through an APR-DRG/SOI-based budget allocation whose weights are based on average length of stay (LOS) rather than cost weights. The Belgian Health Care Knowledge Centre (KCE) has...
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Designing the Belgian “To Be” State: Transforming MZG/RHM and Finhosta for Patient-Based Costing, Care-Process Alignment, and DRG Reform

Introduction In Belgium, hospital financing reform should start from the target state to be achieved rather than from the inherited institutional configuration to be incrementally adjusted. That is especially important because the Belgian health system is structurally path-dependent: it combines near-universal compulsory insurance with direct access, predominantly fee-for-service remuneration, and a division of responsibilities between the federal state and the federated entities that was deepened by the sixth State reform. In hospital financing, Belgium already uses All Patient Refined Diagnosis Related Groups (APR-DRG)/Severity of Illness (SOI) information for budget allocation, but not as a true case-based payment system with national cost weights; the current B2 logic of the Budget of Financial Means (BFM) uses national average length of stay by APR-DRG/SOI as a proxy for resource use. At the same time, Belgium has two mandatory hospital datasets with major strategic value: Minima...
Location: België
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