Clinical Costing: the experience of the Italian Healthcare Network (N.I.San.)

Abstract

Healthcare systems increasingly require accurate and patient-centered cost information to ensure sustainability and informed decision-making. Clinical Costing, based on Health Activity-Based Costing (HABC), provides a structured methodology to determine full costs, understand cost drivers, and support benchmarking activities. This study describes the Clinical Costing framework and its components—Health Activity Costing, Health Performance Costing, Patient Level Costing, and Health Management Costing—along with the experience of the Italian Healthcare Network (N.I.San.), which annually validates and processes hospital discharge data. N.I.San. has developed one of Europe’s largest databases on hospitalization costs, covering nearly 13 million discharges and offering detailed cost matrices, workload indicators, and standardized reference values. These tools enable precise benchmarking, highlight inefficiencies, and identify resource gaps. Clinical Costing offers a reliable and actionable approach for enhancing transparency, efficiency, and strategic planning, supporting equitable allocation of healthcare resources.