Hospital costs and hospital charges.
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Costs and Cost Analysis↗
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Medicare program; limitations on reimbursable hospital costs and the rate of hospital cost increases--HCFA. Final rules.
These rule revise and establish as final rules the interim rules published September 30, 1982 (47 FR 43282) implementing section 101 of the Tax Equity and Fiscal Responsibility Act of 1982. These rules make exceptions available to hospitals consistent with the new cost limits (published elsewhere in this issue of the Federal Register), specifically exempt from those cost limits rural hospitals with less than 50 beds in existence as of the enactment of the law, and establish a ceiling on the allowable annual rate of increase in operating costs per case for inpatient hospital services. The rate of increase ceiling takes from the form of a target amount of cost per case against which a hospital's incurred cost per case will be compared, and includes incentives for hospitals to keep their cost increases below the target rate.
Centers for Medicare and Medicaid Services, U.S.↗
Hospital costs associated with agricultural machinery injuries in Ontario.
To assist those responsible for agricultural safety, we: (1) piloted an approach to costing hospitalized farm injuries; and, (2) described ambulance and inpatient costs associated with these injuries in Ontario. Hospital discharge records (hospital separations) for farm machinery injuries in Ontario (n = 1,610) were identified by ICD9-CM E-codes for 1985-1993. Ambulance costs were estimated by the Ontario Ministry of Health. For each case, the hospital costs were calculated by multiplying the case-specific resource intensity weight by the average inpatient cost per weighted case. The costs (1993 Canadian dollars) ranged from $768 to $62,643 and totaled $6.9 million over the study period. Males accounted for 89.8% of the total costs. Tractor injuries accounted for a large proportion of costs (34.3%). The median costs per case varied by type of machinery, ranging from $2,043 for ploughs/disks to $3,366 for augers. Entanglement injuries were responsible for the largest proportion of costs (40.7%), while tractor rollovers accounted for the highest median cost ($3,065). Although these figures represent a fraction of the total costs associated with farm injuries, the results provide one basis from which to justify and target preventive initiatives. This approach to costing may also be widely applicable to other health issues.
Adolescent↗
Uncertain demand, the structure of hospital costs, and the cost of empty hospital beds.
In this paper we reformulate the theory of cost and production to take account of uncertain demand facing a firm. In the reformulated theory the duality between cost and production no longer obtains, and demand distribution parameters enter the cost function as well as the traditional outputs and input prices. We then estimate a short run cost function for a hospital facing uncertain demand using data from a national sample of over 5000 hospitals for the years 1983-1987. The traditional cost model is strongly rejected in favor of the reformulated model. This model is used to calculate the cost of empty hospital beds, controlling for the effect of uncertain demand on the structure of hospital costs. The cost of an empty hospital bed is calculated as $36,443 in 1987 dollars. We estimate that a one percent decrease in the number of hospital beds would decrease hospital costs by slightly over one-third of one percent. Increasing the occupancy rate from the average 1992 level (65 percent) back to the average 1980 level (76 percent) is estimated to save the average hospital over $2 million, or 9.5 percent of costs.
American Hospital Association↗
Hospital costs: analysis of hospitals over 500 beds.
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Beds↗
"How might a low-cost hospital system look?" Lessons from the Rochester experience.
An innovative, collaborative approach to promoting the effective and efficient delivery of hospital services and to maintaining the solvency of the nine participating hospitals in the greater Rochester, New York area has been successful. An evaluation of the early years (1980-1984) of the Hospital Experimental Payments Program (HEP) shows: 1) per capita hospital costs in Rochester increased at half the rate of increase of the national average; 2) by 1984, per capita hospital expenditures were at $446 compared with $521 nationally; 3) cost containment was achieved through a wide array of strategies such as changes in hospital resource allocation and physician practice patterns; and 4) during the same period, quality and access remained stable or improved. This project demonstrates that through self-control, hospitals can become efficient providers of health care.
Cost Control↗
Do acute care for elders units increase hospital costs? A cost analysis using the hospital perspective.
OBJECTIVE: To compare the hospital costs of caring for medical patients on a special unit designed to help older people maintain or achieve independence in self-care activities with the costs of usual care. DESIGN: A randomized controlled study. PARTICIPANTS: A total of 650 medical patients (mean age 80 years, 67% women, 41% nonwhite) assigned randomly to either the intervention unit (n = 326) or usual care (n = 324). MEASURES: The hospital's resource-based cost of caring for patients was determined from the hospital's cost-accounting system. The cost of the intervention program was estimated and included in the intervention patients' total hospital cost. RESULTS: The development and maintenance costs of the intervention added $38.43 per bed day to the intervention patients' hospital costs. As a result, the cost per day to the hospital was slightly higher in the intervention patients than in the control patients ($876 vs $847, P = .076). However, the average length of stay was shorter for intervention patients (7.5 vs 8.4 days, P = .449). As a result, the hospital's total cost to care for intervention patients was not greater than caring for usual-care patients ($6608 in intervention patients vs $7240 in control patients, P = .926). Sensitivity analysis demonstrated that the cost of the intervention program would need to be 220% greater than estimated before intervention patients would be more expensive then control patients. There were no examined subgroups of patients in whom care on the intervention unit was significantly more expensive than care on the usual-care unit. Ninety-day nursing home use was lower in intervention than control patients (24.1% vs 32.3%, P = .034). Ninety-day readmission rates (36.7% vs 41.1%, P = .283) and caregiver strain scores (3.3 vs. 2.7, P = .280) were similar. CONCLUSION: Caring for patients on an intervention ward designed to improve functional outcomes in older patients was not more expensive to the hospital than caring for patients on a usual-care ward even though the intervention ward required a commitment of hospital resources.
Activities of Daily Living↗
BRIEF report on hospital costs.
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Hospital Administration↗
HOSPITAL costs.
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Hospital Administration↗
HOSPITAL costs.
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Hospital Administration↗
HOSPITAL costing.
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Hospital Administration↗
The sources of hospital cost variability.
Hospital heterogeneity is a major issue in defining a reimbursement system. If hospitals are heterogeneous, it is difficult to distinguish which part of the differences in costs is due to cost containment efforts and which part cannot be reduced, because it is due to other unobserved sources of hospital heterogeneity. In this paper, we apply an econometric approach to analyse hospital cost variability. We use a nested three-dimensional database (stays-hospitals-years) in order to explore the sources of variation in hospital costs, taking into account unobservable components of hospital cost heterogeneity. The three-dimensional structure of our data makes it possible to identify transitory and permanent components of hospital cost heterogeneity. Econometric estimates are performed on a sample of 7314 stays for acute myocardial infarction (AMI) observed in 36 French public hospitals over the period 1994-1997. Transitory unobservable hospital heterogeneity is far from negligible: its estimated standard error is about 50% of the standard error we estimate for cost variability due to permanent unobservable heterogeneity between hospitals.
Adult↗
The relationship between quality and costs: factors that affect the hospital costs of radical prostatectomy.
The present study seeks to establish a relationship between the quality of a surgical procedure and the subsequent hospital costs for that procedure by investigating the influence of both patient and peri-operative factors on the hospital costs of radical prostatectomy. All men who underwent radical prostatectomy at one institution during an 18-month period were included in this study. Clinical information was obtained from medical records and cost information was obtained from hospital billing data. The medical record was also used to determine peri-operative information such as operating room time, anesthesia time, surgical time, blood loss and units of packed red blood cells transfused. The correlation between costs and both clinical and peri-operative factors were determined using the Pearson correlation co-efficient. One hundred and four men underwent radical prostatectomy at our institution during the time period studied. Mean age of these patients was 60.2 y and mean length of stay for these patients was 3.4 days with a range of 2-10 days. Mean total hospital costs for this cohort was $5305 with a range of $2851-$10 358. Significant correlations with total hospital costs included operating room time, surgical time, estimated blood loss and blood transfused. Patient factors such as age, ASA class, co-morbidities and smoking history were not correlated with total hospital costs. The present study demonstrates that factors at least partially controlled by the surgeon such as surgical time and units of blood transfused directly influence the total hospital costs of radical prostatectomy, while patient factors such as age and the presence of co-morbidities had no significant correlation with total hospital costs. These findings demonstrate that surgeons can impact health care costs by providing high quality care and begins to establish a relationship between high quality care and low cost care.Prostate Cancer and Prostatic Diseases (2001) 4, 213-216.
Journal Article↗
Epidemiology, clinical course and impact on hospitalization costs of acute diarrhea among hospitalized children in Athens, Greece.
The aim of this study was to describe the etiology, morbidity and hospitalization costs associated with acute diarrhea among hospitalized children in Greece. During 1999, 294 hospitalized children (median age 1 y) with acute diarrhea were prospectively studied. Bacterial and viral enteropathogens were detected in 100 (34%) and 37 (12.5%) patients, respectively; 17 (6%) patients had mixed infections. Isolated agents included Salmonella spp. (43 patients; 15%), rotavirus (32; 11%), Campylobacter spp. (26; 9%), enteropathogenic Escherichia coli (16; 5.5%), Shigella spp. (11; 4%), Aeromonas spp. (7; 2.5%), adenovirus (6; 2%), Yersinia enterocolitica (6; 2%), enterohemorrhagic Escherichia coli (2; 0.5%) and Giardia lamblia (1; 0.5%). Of the patients with bacterial infection, 70% were admitted between April and September 1999. A rotavirus-associated peak was noted in March. Patients with a bacterial infection were hospitalized for longer periods than those with viral infections. It is concluded that bacterial enteropathogens account for one-third of admissions due to acute diarrhea among children in Greece and are associated with significant hospitalization costs. Rotavirus is also a frequent cause of acute diarrhea necessitating hospitalization.
Acute Disease↗
Hospital cost is reduced by motorcycle helmet use.
BACKGROUND: The purpose of this study was to identify the impact of motorcycle helmet use on patient outcomes and cost of hospitalization, in a state with a mandatory helmet law. METHODS: Patients admitted after motorcycle crashes from July 1996 to October 2000 were reviewed, including demographics, Injury Severity Score, length of stay, injuries, outcome, helmet use, hospital cost data, and insurance information. Statistical analysis was performed comparing helmeted to unhelmeted patients using analysis of variance, Student's test, and regression analysis. RESULTS: We admitted 216 patients: 174 wore helmets and 42 did not. Injury Severity Score correlated with both length of stay and cost of hospitalization. Mortality was not significantly different in either group. Failure to wear a helmet significantly increased incidence of head injuries (Student's test, p < 0.02), but not other injuries. Helmet use decreased mean cost of hospitalization by more than $6,000 per patient. CONCLUSION: Failure to wear a helmet adds to the financial burden created by motorcycle-related injuries. Therefore, individuals who do not wear helmets should pay higher insurance premiums.
Accidents, Traffic↗
The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage.
In this paper, we report the results of an analysis of hospital expenses in 43 large SMSAs between 1980 and 1984. We found that hospital rate regulation--specifically Medicare's TEFRA and PPS and state multi-payer systems--was the single most important factor leading to the slowdown in the rate of increase in hospital costs between 1980 and 1984. In 1984, hospital costs covered by Medicare's PPS were 12.5% lower than they would have been in the absence of rate regulation, and in the four states covered by all-payer rate regulation, hospital costs were between 11% and 15% lower. In contrast, changes in the proportion of people either covered by employer-group health insurance or enrolled in HMOs, reduced hospital costs by less than 1%. Measures of competition suggest that hospital costs are higher where there is more competition. We also found that almost all of the effect of regulation on costs came from gains in the efficiency of producing hospital care and/or from reductions in the quality of care. It appears that controlling hospital payment rates gave hospitals a strong incentive to provide care at lower cost.
Catchment Area, Health↗
Comorbid illness affects hospital costs related to hip arthroplasty: quantification of health status and implications for fair reimbursement and surgeon comparisons.
Optimized resource allocation, reimbursement negotiations, and provider comparisons hinge on an understanding of the drivers of healthcare costs. Indices of comorbid illness may be useful for stratifying patients based on cost. Total hospital cost was analyzed for 1 surgeon's hip arthroplasty patients (June 1998-March 2001). Three scales of health status were selected as independent predictors. One thousand ninety-two hip arthroplasty inpatient stays were evaluated. The median total hospital cost was 14,011 dollars. An increasing burden of comorbid illness as measured by the All Patient Refined Diagnosis Related Group Severity of Illness scale and the modified Charlson Comorbidity Index was significantly associated with increasing hospital cost. Comorbid illness is associated with cost; scales may be used to stratify patients based on risk of high cost care.
Adolescent↗