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Health service costs for patients on the waiting list
Hude Quan1, Rene Lafreniere, David Johnson
1Department of Community Heolth Sciences, University of Calgary, Alta. hquan@ucalgary.ca
Insights
This study found no evidence that longer surgical wait times increase health service costs. Wait times for common procedures like hip or knee replacements did not correlate with higher pre- or post-operative expenditures.
Area of Science:
- Health Services Research
- Health Economics
- Surgical Outcomes
Background:
- Healthcare systems often face resource limitations impacting surgical scheduling.
- Understanding the economic implications of surgical delays is crucial for resource allocation.
Purpose of the Study:
- To investigate whether delays in common surgical procedures lead to increased healthcare service costs.
- To determine if surgical wait times are associated with higher pre- or post-operative expenditures.
Main Methods:
- Retrospective cohort study of 4441 patients undergoing cholecystectomy, discectomy, hysterectomy, or knee/hip replacements.
- Analysis of physician claims, home care, and pharmaceutical costs one year before and after surgery.
- Utilized administrative records and waiting time data from Calgary urban hospitals (1997/98).
Main Results:
- Median wait times varied, with joint replacements having the longest waits (knee: 88 days, hip: 65 days).
- Total physician claim costs decreased post-surgery across all procedures (4-30%).
- Longer waits were not linked to increased physician claim costs or senior prescription costs pre- or post-operatively.
Conclusions:
- No evidence suggests surgical wait times correlate with increased health service expenditures.
- Surgical wait time is not a reliable proxy for overall health service utilization.
- Health service costs did not significantly increase due to delays in these common surgical procedures.
Objective:
To find out if the cost of health services was artificially increased because of a delay in surgery due to a lack of resources.
Design:
A retrospective cohort study.
Setting:
Three urban hospitals in Calgary, Alta.
Patients:
The study cohort comprised 4441 patients (1 index procedure for each patient).
Interventions:
Cholecystectomy, discectomy, hysterectomy, total knee and total hip replacements.
Outcome Measures:
The costs for physician claims, use of home care and pharmaceutical prescriptions 1 year before and after the selected procedures, using 1997/98 administrative records and waiting times maintained by Alberta Health and Wellness and Calgary Regional Health Authority.
Results:
The median wait for joint surgery (88 d for knee replacements and 65 d for hip replacements) was longer than for the other selected procedures (29 d for cholecystectomies, 21 d for discectomies and 42 d for hysterectomies). Total per patient physician claim costs decreased after surgery (cholecystectomy--30%, discectomy--24%, hip replacement--6%, hysterectomy--23% and knee replacement--4%). Seeing the procedure specialist more than once preoperatively was associated with a greater decrease in postoperative physician claim costs. Longer waits were not associated with more physician claim costs or Blue Cross prescriptions claim costs for seniors (> or = 65 yr) in the year before or after surgery nor were they associated with more physician claim costs during the actual wait compared with a matched postoperative time period.
Conclusions:
No evidence was found to suggest that waiting for 1 of 5 common surgical procedures is correlated with greater health service expenditures pre- or postoperatively. In this study, wait time is not a proxy for health service use nor do health service costs decrease markedly after surgery.