Value creation happens when hospitals provide new services or clinicians deliver existing services in better or more cost efficient ways. On the other hand, those who deliver healthcare can extract financial value from the system. Cost-based prices are now potent measures of financial value for profit centres in English hospitals. Here, we focus on the ramifications of these cost-based prices for creating or extracting value in the health care system.

Our empirical data is drawn from: first, semi-structured interviews with Clinical Directors who head up profit centres in English hospitals; and, second, documentary sources which reveal how accounting drives costing for health treatments. From these data sources we identify three valuing activities which mobilise cost-based prices: “bubble” charts; “up-coding” and business cases in the context of a joint venture.

We conclude that cost-based pricing can create public value because it incentivizes clinical activity and can be used to enhance health care quality. But the traditional accounting mode for cost-based pricing advantages standardised care while disadvantaging complex care, this generates opportunities for value extraction for those, including some private sector providers, who deliver standardised care. Our analysis encompasses three different levels: the profit centre based on a specialty, the hospital and the entire health care system. This broad appraisal reveals that value creation at the level of the individual profit centre can become value extraction for the hospital and the health care system as a whole.

当医院提供新服务或临床医生以更好或更具成本效益的方式提供现有服务时，就会创造价值。另一方面，提供医疗保健的人可以从系统中获取财务价值。现在，基于成本的价格是英国医院利润中心财务价值的有力衡量标准。在这里，我们关注这些基于成本的价格对在医疗保健系统中创造或提取价值的影响。

我们的经验数据来自：首先，对负责英国医院利润中心的临床主管进行半结构化访谈；其次，揭示会计如何推动健康治疗成本核算的文献资料。从这些数据源中，我们确定了三种调动基于成本的价格的估值活动：“气泡”图；合资企业背景下的“升级”和商业案例。

我们得出结论，基于成本的定价可以创造公共价值，因为它可以激励临床活动，并可用于提高医疗保健质量。但是，基于成本的传统会计模式有利于标准化护理，而不利于复杂护理，这为那些提供标准化护理的人（包括一些私营部门提供者）创造了价值提取的机会。我们的分析包括三个不同的层次：基于专业的利润中心、医院和整个医疗保健系统。这种广泛的评估表明，个人利润中心层面的价值创造可以成为医院和整个医疗保健系统的价值提取。