Objectives: To evaluate the payment rates and treatment cost for case by case appendicitis at Sonla General Hospital. Subjects and methods: This was a study of hospital cost analysis, using qualitative methods to evaluate the treatment cost of acute appendicitis in 322 patients undergoing laparoscopic and open appendectomy in Sonla Provincial General Hospital from 01 - 2012 to 12 - 2013.
Trang 1EVALUATION OF PAY PACKAGES AND COMPONENTS
PAYMENT FOR THE CASE OF APPENDECTOMY IN SONLA PROVINCIAL GENERAL HOSPITAL IN 2012 - 2013
Nguyen Duc Toan*; Pham Le Tuan**; Quach Thi Can***
SUMMARY
Objectives: To evaluate the payment rates and treatment cost for case by case appendicitis
at Sonla General Hospital Subjects and methods: This was a study of hospital cost analysis, using qualitative methods to evaluate the treatment cost of acute appendicitis in 322 patients undergoing laparoscopic and open appendectomy in Sonla Provincial General Hospital from
01 - 2012 to 12 - 2013 The costs included the general expenses and payment receipts from the insurance agencies; the cost of the drug expenditure such as testing, material consumption Data were collected and analyzed by STATA 14.0 Results and conclusion: The average cost of laparoscopic and open appendectomy according to case payment in 2012 (3,203.1 thousand VND and 2,819.9 thousand VND) lower than fee for services in 2013 (6,252.5 thousand VND and 5,238.0 thousand VND), the difference was statistically significant with p < 0.001
* Keywords: Appendicitis; Treatment costs; Pay packages and components
INTRODUCTION
Currently, the insurance system
(HEALTH INSURANCE) of the developed
countries is gradually replacing treatment
cost examination by service fees by more
active methods: periodic payment and
case-based payment [1, 4, 7] The latter is
a paying treatment cost according to
predefined prices for each case This
payment level is built based on professional
process accounting, including all the
services provided for a specific disease
cases from patient admission to discharge
Hospital is paid a predetermined fee for
each illness, if the cost of treatment for
patients is less than predetermined outlay,
the hospital will be entitled to profit and vice versa, hospital can also must compensate [5, 6]
The Government's policy guidelines on health finance and actual activities of the hospital set out the requirements of research, the application of more advanced payment methods such as periodic payment and packages according to cases to supplement and replace the direct payment service Derived from the above requirements, the
study was conducted aiming to: Evaluate
the cost of pay packages and components for the cases of appendectomy disease
in Sonla Provincial General Hospital in
2012 - 2013
* Sonla Provincial Hospital
** Ministry of Health
*** Otorhinolaryngological Central Hospital
Trang 2SUBJECTS AND RESEARCH
METHODS
1 Subjects and sample size
The study consists of 322 patients treated
by open appendectomy (OA) and laparoscopic
appendectomy (LA) at Sonla Provincial
General Hospital from 01 - 2012 to
12 - 2013
2 Method
* Research design: Hospital cost was
analyzed by the qualitative methods
* Viewpoint: Evaluate the payment
rates and cost of components for each
case of appendicitis at Sonla General
Hospital
* Study variables: Age; time from
illness to surgery (hour); time from house
to hospital (minute); hospitalization stay
length; the cost of OA/LA by components
fee and total payment in 2012 - 2013 (number of days of treatment; cost of test/antibiotics/pain relief/infusion/drug others/surgery/total prescription/total payment by Health Insurance System and patient’s payment) Costs of this accounting cost perspective of hospital are taken from the accounting data of hospital with the charges and payment from the insurance agency/patients with drug costs, consumables, test Total cost was calculated by components listed above, health insurance and patient’s payment
* Data collection and processing: Data
on inpatient charges were extracted from hospital financial software during 2012,
2013 Data after cleaning were then entered, managed and analyzed using STATA 14.0 statistical software
RESULTS
Table 1: Some characteristics of the study groups
Gender
0.08a
(a: Chi-squared test; f: Mann-Withney test)
Some factors including age, time from illness to surgery, time from home to hospital, hospitalization stay length differed between the two study groups
Trang 3Table 2: The cost of OA by components fee and total payment in 2012 - 2013
(Unit: thousand VND); f Mann-Withney test; HI: Health Insurance; P: Patient)
For OA, the cost covered by health insurance includes as ultrasound, test, analgesic, infusion, other prescription drugs, surgical costs, supplies for surgery and treatment in
2013 were higher and more significantly different from p < 0.05 compared to 2012 With the above components paid by the patient, there was hardly any difference with
p > 0.05, among which supplies and other components were different with p < 0.05 The total cost of health insurance paid for an OA in 2013 was 2,608 million VND higher than that of 998.1 thousand VND in 2012; the total cost that patients paid for an
OA in 2013 was 623.9 thousand and in 2012 was 607.6 thousand The total cost for an
OA in 2013 was 6,252 million VND, up from 3,203 million VND in 2012 The difference was statistically significant with p < 0.05
Trang 4Table 3: The cost of LAS by components fee and total payment in 2012 - 2013
(Unit: thousand VND) f Mann-Withney test HI: Health Insurance; P: Patient)
Costs for a LA case paid by Health Insurance include the following components: ultrasound, laboratory tests, surgical costs, materials consumed during surgery in 2013 was higher with statistically significant difference (p < 0.05) compared to 2012 Other components such as antibiotics, painkillers, fluids, prescription drugs, medical supplies for treatment and total treatment was not different between two years
The treatment cost, antibiotics, additional fees for surgery, supplies for surgery, other medical supplies, total treatment is significantly different with p < 0.05 between
2013 and 2012 The other components were not significantly different (p > 0.05) The total cost for an OA in 2013 was 5,538 million VND, down to 2,819.9 million VND in 2012 The difference was statistically significant with p < 0.05
Trang 5Figure 1: Cost by LA and OA in 2012 - 2013
DISCUSSION
The level of pay packages according to
cases charged for a service package
defined for each group of similarities:
diagnosis, services needed and the costs
required This payment level is built on
the basis of accounting that includes all
the services provided for a specific disease
cases from hospital admission to discharge
[4, 5, 7]
In this study, the accounting is based
on price components and calculated on a
component-by-case basis and on all
out-of-pocket payments After computation,
we found that the average cost per case
for OA in 2012 and 2013 (3,203.1
thousand VND and 6,252.5 thousand VND) was higher than the cost per one LA case
2012 and 2013 (p < 0.001)
Therefore, if conducted pay packages according to cases, the cost of the hospital and the cost of the patient must be taken into account This result is also consistent with Duong Huy Lieu et al’s review [2] when applying the professional process for the disease group of acute appendicitis
in Thanhnhan Hospital and Bavi, Hanoi
He saw the advantages of the method of case-based package payment, which enhances management improvement in hospital, reduces unreasonable costs and more transparency with the internal auditing
3203.1
2819.8
6252.5
5238
7000
6000
5000
4000
3000
2000
1000
0
N¨m 2012
N¨m 2013
Trang 6and independent auditing, improves
operational efficiency, reduces the
average time and the use of drugs and
tests In Sonla Provincial Hospital, this
professional procedure has been applied
and shows a significant cost reduction
between both methods of surgery for
patients with acute appendicitis in 2012
and 2013
After an analysis of data of the
appendectomy patients before and after
implementation of pay packages according
to cases, Kim K.H et al (2016) [5] saw a
decrease in postoperative period (2.8 ±
1.0 vs 3.4 ± 1.9 days on, p < 0.001), but
no reduction in the total cost of the hospital
The independent factors associated with
the costs were patients of 70 years of age
or more (OR = 3.214; 95%CI: 1.769 - 5.840;
p < 0.001) and surgical time longer than
100 minutes (OR = 3.690; 95%CI: 6.599,
p < 0.001 - 2.007) In addition, patients
≥ 70 years old had a risk of accompanied
infections nearly as high as 10 times
(95%CI: 20.214; p < 0.001, 5.141) and
hospital risks were as high as 3.255 times
(95%CI: 1.731, p < 0.001, 6.119)
CONCLUSIONS
The average cost for an OA case
recorded in 2012 and 2013 (3,203.1
thousand VND and 6,252.5 thousand
VND) was higher than the cost for one LA
in 2012 and 2013 (2,819.9 thousand VND
and 5,238 thousand VND) The difference was statistically significant with p < 0.01
REFERENCES
1 Tran Van Tien Payment service fees,
hidden risks Journal of Medical Information
2001, 10
2 The Ministry of Health, Ministry of Finance Circular No 04/2012 of Ministry of
Health and Ministry of Finance dated 29/02/2012 issued a maximum framing some examination and treatment in medical establishments The Healing of the State 2012
3 Vu Van Le, Pham Tuan, Nguyen Thi Kim Tien Some of the changes in clinical
practice and patient costs in two pilot hospitals pay packages according to the patients Journal of Practical Medicine 2012,
5 (820), pp.2-5
4 Edgar Hagenbichler The Austrian DRG
system Federal Ministry of Health 1st edition,
2010, July
5 Kim K.H, Lee S.C, Lee S.K et al Does
Korea's current diagnosis-related group-based reimbursement system appropriately classify appendectomy patients? Ann Surg Treat Res
2016, 91 (2), pp.66-73
6 Kwon S Payment system reform for
health care providers in Korea Health Policy and Planning 2003, 18 (1), pp.84-92
7 Song J.K, Kim C.Y Participation
determinants in the DRG payment system of obstetrics and gynecology clinics in South
Korea J Prev Med Public Health 2010, 43 (2),
pp.117-124