Critically discuss:

a) Why Cambridge Hospital Community Health Network embarked on the ABC study?

There are two main reasons why the Cambridge Hospital Community Health Network (the Network) embarked on the Activity Based Costing (ABC) study. Firstly, the Network needed to gain a better understanding of its unit-of-service costs, which had been rising at a rate of 10% per year. In fact it had recently been rated the third-highest cost hospital in the state of Massachusetts. Being a high cost provider could make the Network uncompetitive for Medicaid and other public contracts. Secondly, the Network’s new operating budget required a $14 million reduction, which represented 15% of the total hospital network’s operating budget, in expenditures during the next two fiscal years. This was largely due to the downward pressure on hospital revenues by the government reform and managed care forced providers to cope with conditions that were constantly changing, while continuing to provide quality health care services in a time of intense competition.

The Network's traditional method of analysing costs is the Medicare step-down costing system. It gave little information about the cost at the unit of service level. It gave only aggregate costing information (i.e. information about the departmental or global costs) but it does not provide the costs at the patient or procedure level that is needed in order to push cost reduction and also price their services competitively.

Moreover, there was some concern that it might be inaccurately representing the true cost of the intern and resident program, the interpretive services department, and the use of nurse practitioners. Those costs were not directly traceable to the service cost centers but that were traceable to the activity. Knowing the actual cost at the service level became critical in the new fixed