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A comparison of hospital costs with reimbursement received for patients undergoing the Norwood procedure for hypoplasia of the left heart

Published online by Cambridge University Press:  16 September 2005

Vinod Mishra ,
Harald Lindberg ,
Egil Seem ,
Ingrid Klokkerud ,
Britt Fredriksen ,
Øyvind Skraastad ,
Anna Østlie ,
Sølvi Andresen  and
Stein Vaaler
Vinod Mishra
Affiliation:
Hospital Management/Health Professional Support Department, Rikshospitalet University Hospital, Oslo, Norway
Harald Lindberg
Affiliation:
Department of Congenital Cardiac Surgery, Rikshospitalet University Hospital, Oslo, Norway
Egil Seem
Affiliation:
Department of Congenital Cardiac Surgery, Rikshospitalet University Hospital, Oslo, Norway
Ingrid Klokkerud
Affiliation:
Department of Congenital Cardiac Surgery, Rikshospitalet University Hospital, Oslo, Norway
Britt Fredriksen
Affiliation:
Pediatric Cardiothoracic Intensive Care Unit, Rikshospitalet University Hospital, Oslo, Norway
Øyvind Skraastad
Affiliation:
Department of Anaesthetics, Rikshospitalet University Hospital, Oslo, Norway
Anna Østlie
Affiliation:
Department of Anaesthetics, Rikshospitalet University Hospital, Oslo, Norway
Sølvi Andresen
Affiliation:
Hospital Management/Health Professional Support Department, Rikshospitalet University Hospital, Oslo, Norway
Stein Vaaler
Affiliation:
Hospital Management, Rikshospitalet University Hospital, Oslo, Norway
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Abstract

Objectives: To determine whether the present system of reimbursement, based on diagnosis-related groups and regular financial budgeting, covers the costs incurred during hospitalisation of 7 children undergoing the three stages of the Norwood sequence for surgical treatment of hypoplastic left heart syndrome. Methods: Between January and September 2003, 7 patients underwent initial surgical palliation with the Norwood procedure at the Rikshospitalet University Hospital. A prospective methodology was developed by our group to measure the costs associated with each individual patient. The patients were closely observed, and the relevant data was collected during their stay in hospital. The stay was divided into four different periods of requirements of resources, defined as heavy intensive care, light intensive care, intermediate care, and ordinary care. At each stage, we recorded the number of staff involved and the duration of surgery and other major procedures, as well as the cost of pharmaceuticals and other consumables. Based on these data, we calculated the cost for each patient. These costs were compared with the corresponding revenue received by the hospital for each of the patients. Results: We found the total mean cost for the three stages of the Norwood sequence was 138,934 American dollars, while the corresponding revenue received by the hospital was 43,735 American dollars. During this period, one patient died during the first stage of the Norwood sequence. Conclusions: Our study shows that steps involved in the Norwood sequence are low-volume but high-cost procedures. The reimbursement received by our hospital for the procedures was less than one-third of the recorded costs.

Keywords

Hypoplastic left heart syndromein-hospital costdiagnosis-related groups
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 5 , October 2005 , pp. 493 - 497
Copyright
© 2005 Cambridge University Press

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