Optimizing Hospital Costs: A Bibliometric-Systematic Analysis of the Methodological Transition to Time-Driven Activity-Based Costing

Cost management in the medical sector represents a critical challenge for public hospitals worldwide as they struggle to balance budget constraints with the delivery of high-quality medical care. Although the activity-based costing (ABC) system and its simplified variant, time-driven activity-based costing (TDABC), have proven superior to traditional volume-based methods, the current academic literature lacks a systematic evaluation of their coexistence and evolution, particularly in transitional economies. This study employs a Bibliometric-Systematic Literature Review (B-SLR) methodology to analyse 78 open-access articles published between 2006 and 2026, extracted from the Web of Science Core Collection (WoS). Using bibliographic coupling and thematic analyses, the research examines temporal evolution, geographic distribution, and structural relationships among these ABC/TDABC methodologies. The results show exponential growth in scientific output beginning in 2020, driven by pandemic-induced efficiency pressures. The critical point of this analysis is the empirical refutation of the hypothesis of simple methodological substitution, highlighting instead a paradigm characterised by integration, in which TDABC holds supremacy in surgical contexts with standardised processes, while ABC retains critical importance in complex emergency medical situations. The study makes a significant contribution through empirical documentation of the methodological shift toward hybrid models and by exposing a serious research gap in Eastern European contexts. These results offer hospital management a framework for selecting cost accounting tools and identify environmental sustainability and the integration of decision-support as sources of innovation for future investigations.