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We have analysed the cost of disposable equipment used during cataract surgery by eight different surgeons over a six-month period in the same hospital. By comparing the costs of single-use items used by each surgeon we highlight how significant savings can be made by change of technique (without an adverse effect on surgical outcome).
OBJECTIVE: To assess the diagnostic efficiency and costs of protocols used for investigating patients with suspected lesions of the cerebellopontine angle. DESIGN: Prospective evaluation of tests of auditory brain stem responses and acoustic reflex thresholds, electronystagmography, and calorics. Positive test results were confirmed or refuted by high resolution computed tomography with intravenous enhancement. SETTING: Single general otolaryngology clinic in a teaching hospital. PATIENTS: 270 consecutive patients with sensorineural hearing loss requiring investigation to exclude a lesion of the cerebellopontine angle. MAIN OUTCOME MEASURES: Estimated costs of various diagnostic protocols and performance in detecting tumours of the cerebellopontine angle. RESULTS: Protocols including tests of auditory brain stem responses and acoustic reflex thresholds as sifting tests before computed tomography were clinically acceptable and presented considerable savings over the use of computed tomography in all patients (74,000 pounds or 84,000 pounds v 122,000 pounds). The use of electronystagmography and calorics could not be justified on clinical or financial grounds. CONCLUSIONS: Audiological tests of auditory brain stem responses and acoustic reflex thresholds followed by computed tomography constitute the most cost effective protocol for determining suspected lesions of the cerebellopontine angle. IMPLICATIONS: The cost effectiveness of diagnostic protocols should be evaluated throughout the health service.
OBJECTIVES: To cost a clinical unit over one month in 1991, to cost treatment of individual patients from audit data, and to compare this costing method with the hospital charging system. DESIGN: A financial breakdown was obtained for one month's work. Ward stay, operating time, investigations, and outpatient visits were costed and a formula (episode = days on ward+hours of operating+investigations+outpatient visits) was used to cost patient episodes from audit data. SETTING: The adult urology unit in a teaching hospital. MAIN OUTCOME MEASURES: Costs for each part of patients' treatment. RESULTS: Total cost was 147,796 pounds for 159 admissions, 738 inpatient days, 131 operations in 29 operating lists, and 615 outpatient visits. An uncomplicated transurethral prostatectomy cost 1140 pounds but complications increased this to 1500 pounds in another patient. The costs of diagnostic cystoscopy were 130 pounds in outpatients, 240 pounds in day surgery, and 430 pounds in inpatients. Hospital charges do not reflect the individual costs of treatment, charges being greater than costs for some patients and lower than costs for others. CONCLUSIONS: Clinicians can produce a financial analysis of their work and cost their patients' treatment. Audit is strongly advocated as a resource planning tool.
Audit will soon be common-place and obligatory. The task will be difficult to perform manually but becomes simple and straightforward using the practice computer. Extensive clinical and financial audit may be easily derived from practice daily activities recorded on the computer.
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In the absence of developing a relationship between price paid and cost expended, health care management has no basis for setting financial objectives much less subsequent evaluation. Departmental P&Ls bring the cost-price relationship into perspective.
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We investigated differences among five types of hospitals, defined by ownership (investor-owned or not-for-profit), system affiliation (system-affiliated or freestanding), and government sponsorship on 24 measures of economic performance. Using multivariate analysis of 1980 Medicare cost report and other data from a national sample of 561 hospitals, we found that investor-owned chain hospitals charged significantly more, and were more profitable, than all other types of hospitals except freestanding for-profits; there were no differences in productive efficiency that could be attributed to ownership or affiliation; the investor-owned hospitals had higher debt-to-asset ratios, less-capital-intensive plants, and greater capital costs as a percentage of operating costs than the not-for-profits; and there were no consistent case-mix differences among the hospitals.
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