Activity and cost analysis in surgical pathology. Experience of a french university laboratory using the activity-based costing method

Good self-knowledge enables us to have a well-reasoned adaptation to our en vironment. Starting from this precept based on simple common sense, activit y and cost analysis, when applied to medical departments in a university ho spital setting, represents a necessary phase in their scientific progressio n and in the continuation of their university vocation. This is all the mor e true given the present climate of economic and organizational restructuri ng of medical facilities. This paper relates the experience of a French sur gical pathology department which was assessed for cost effectiveness using the Activity-Based Costing (ABC) method in 1999. This method, which origina ted in the business world and of which the general concepts are presented h ere, has given us a keener understanding of the diverse processes involved, their costs and how these costs are arrived at. Moreover, this method has identified the proportion of costs imputable to diagnostic work and of thos e linked to work specific to a university hospital, in particular teaching and research and development. The results can then be used for a clearer an alysis of the figures required by prescribers and health care funding agenc ies, and, within the department, to enhance perception of work carried out by the entire staff in order to initiate a new type of management centered on activity (Activity-Based Management). Adaptable to any medical departmen t, whatever its organizational structure, independent of the significance o f any given code letter and regardless of the rating method used to grade a ctivities, the ABC method also allows for comparisons between structures of a similar nature. The thoughts it inspires on economic performance must ta ke into account the rules of good medical practice, the imperatives of qual ity assurance, the need for breathing space :, which are indispensable to r esearch and a humanist conception of working relations.