This paper is intended to examine both clinical and economic data concerning the activity of an emergency department of an Italian primary Hospital. Real data referring to arrivals, waiting
times, service times, severity (according to triage classification) of patients? condition collected along the whole 2009 are matched up with the relevant accounting and economic information
concerning the costs faced. A new methodological approach is implemented in order to identify a ?standard production cost? and its variability. We believe that this kind of analysis well fits
the federalizing process that Italy is experiencing. In fact the federal reform is driving our Country toward a decentralized provision and funding of local public services. The health care services are ?fundamental? under the provisions of the law that in turn implies that a standard cost has to be defined for its funding. The standard cost (as it is defined by the law) relies on the concepts of appropriateness and efficiency in the production of the health care service, assuming a standard quality level as target. The identification and measurement of health care costs is therefore a crucial task propaedeutic to health services economic evaluation.Various guidelines with different amount of details have been set up for costing methods which, however, are defined in simplified frameworks and using fictious data. This study is a first attempt to proceed in the direction of a precise definition of the costs inherent to the emergency department activity.