Hospital Costing: Experience from the VHA

The government administered Veterans Health Administration (VHA) is the largest integrated health care system in the USA. As health care dollars are becoming tighter nationwide, VHA faces the dual challenge of achieving cost reductions and improving quality, while operating in an increasingly competitive marketplace. This places new demands on cost accountability within the agency. This paper identifies the cost accounting procedures currently used by VHA as it responds to internal budgetary curtailment and to external competitive pressures. Understanding the different costing approaches taken by the organization along with their associated problems offers lessons of interest to financial managers within and outside VHA.