Hospital treatment -is it affordable? A structured cost analysis of vaginal deliveries and planned caesarean sections

Heer Im, Kahlert S, Rummel S, Kümper C, Jonat W, Strauss, Strauss A

Description

The analysis of cost effectiveness in hospitals is as difficult as treating the patients properly. We are yet not able to answer the simple question of what costs are caused by a certain diagnosis and its treatment during an average hospital stay. Methods To answer some issues of the global problem of cost effectiveness during hospitalisation, we analysed the costs and the cost structure of a normal obstetrical hospital stay during an uncomplicated vaginal delivery and a planned caesarean section. Cost data was collected and summarized from the patients file, the hospital's computer system gathering all cost centres, known material expenses and expenses of non obstetrical medical services. Results For vaginal deliveries/planned caesareans we can calculate with a surplus of about 83 €/1432 €. About 45% of the summarized costs are calculated on a reliable database. Discussion The introduction of the DRG based clearing system in Germany has aggravated the discussion on cost effectiveness. Our meticulous work-up of expenses excluded personal precautionary costs and personnel costs of documentation because no tools are described to depict such costs. If we would add these costs to the known expenses of our study, we strongly suspect that hospital treatment of vaginal deliveries or planned caesarean sections is not cost effective.

Sujets

• Cost-effectiveness analysis
• Vaginal delivery
• Caesarean section
• DRG

Informations

• Publié par: biomed
• Publié le: 01 janvier 2009
• Nombre de lectures: 11
• Langue: English

Extrait

502 EUROPEANJOURNAL OF MEDICAL RESEARCH Eur J Med Res (2009) 14: 502-506

November 3, 2009

© I. Holzapfel Publishers 2009

H OSPITAL T REATMENT - I S IT A FFORDABLE ? A S TRUCTURED C OST A NALYSIS OF V AGINAL D ELIVERIES AND P LANNED C AESAREAN S ECTIONS

1 23 11 1 I. M. Heer, S. Kahlert, S. Rummel, C. Kümper, W. Jonat, A. Strauss

1 Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Kiel, Germany 2 Department of Obstetrics and Gynaecology - University of Munich – Grosshadern, Germany 3 Department of Gynecology and Obstetrics, Klinikum Traunstein, Germany

Abstract Intr oduction:The analysis ofcost effectiveness in hos- pitals is as difficult as treating the patients properly. We are yet not able to answer the simple question of what costs are caused by a certain diagnosis and its treatment during an average hospital stay. Methods:To answer some issues ofthe global problem of costeffectiveness during hospitalisation, we analysed the costs and the cost structure ofa normal obstetrical hospital stay during an uncomplicated vagi- nal delivery and a planned caesarean section. Cost data was collected and summarized from the patients file, the hospital’s computer system gathering all cost cen- tres, known material expenses and expenses ofnon obstetrical medical services. Results:For vaginal deliveries/planned caesareans we can calculate with a surplus ofabout 83€/1432 €. About 45% ofthe summarized costs are calculated on a reliable database. Discussion:The introduction ofthe DRG based clear- ing system in Germany has aggravated the discussion on cost effectiveness. Our meticulous work-up ofex- penses excluded personal precautionary costs and per- sonnel costs ofdocumentation because no tools are described to depict such costs. Ifwe would add these costs to the known expenses ofour study, we strongly suspect that hospital treatment ofvaginal deliveries or planned caesarean sections is not cost effective.

Key words:cost effectiveness, vaginal delivery, caesare- an section, DRG

I NTRODUCTION :

Cost effectiveness has become one ofthe most poplar words in the economic evaluation ofmedical affairs. The reason is the ongoing discussion ofhow to make health systems affordable. But the problem ofcost ef- fectiveness ofmedicine is not easily solved because simple basic economic questions are not yet answered properly. For example, the cost ofthe hospital treat- ment ofa patient over a certain time it is very difficult to name the diversity ofexpenses (i.e. specialists, nurs- es, infrastructure). Is the cost ofthe specialist’s man-

power more expensive than the infrastructure ofthe hospital? Basically we are yet not able to answer the simple question ofwhat costs are caused by a certain diagnosis and its treatment during an average hospital stay. Our study was focused on these problems. To get started with answering some issues ofthe global prob- lem ofcost effectiveness during hospitalisation, we analysed the costs and the cost structure ofa normal obstetrical hospital stay during an uncomplicated vagi- nal delivery and compared our results to a similar analysis ofthe hospital stay after planned caesarean section. We tried to answer the following questions: • Whatare the known individual costs? • Ifthe hospital is paid by the new system ofthe German Diagnose Related Groups (G-DRG): Does the corresponding reimbursement cover the related costs ofthe hospital? • Canthe hospital afford the treatment it offers to the patient? • Whichdata ofthe whole cost analysis can be stated as reliable? M ETHODS Patients:In this retrospective analysis we included only healthy mothers with singleton pregnancies at term. We focused on vaginal deliveries without any obstetri- cal complication or complicating perinatal diagnosis (i.e. diabetes, high blood pressure, infectious diseases). Similarly to this we elected healthy women with planned caesarean sections conducted at term in epidural anaesthesia without any perioperational com- plications. The aim ofthe limitations was to obtain homogenous study populations with a homogenous cost structure to calculate valid average data on the cost structure ofthe hospital stay. Type ofcosts:cost data was collected and summarized from the patients file, the hospital’s computer system gathering all cost centres, known material expenses and expenses ofnon obstetrical medical services. Our analysis was based on the following definition of costspecifications: