Decision making in sanità e misurazione dei costi: due mondi paralleli?

The evolution of health systems increased complexity of the decision-making process in this context. Consequently, the cost measurement tools would have to evolve consistently with the new needs. In practice, however, cost accounting by cost centers has not always been able to incorporate these needs and, indeed, has shown some implementation and use criticalities. This chapter describes the evolution of health systems and related decision-making needs. We report an extensive review of cost accounting experiences in the health sector. Unlike other works, we studied and systematized results considering the process of introducing an accounting by cost centers from the design phase to the consolidation of operational routines. Adequate attention to the various critical issues offers practitioners references to avoid that decision making and cost measurement are parallel worlds destined to meet, perhaps, only in infinity.