[High-risk pregnancy, costs and DRG reimbursement]

The aim of this study was to measure actual costs of delivery of women with high-risk pregnancies in Norway. We calculated the cost difference between Caesarean section delivery and vaginal delivery and compared costs and the reimbursement received by hospitals. The present Norwegian financial system for hospitals has two components: a government reimbursement based on diagnosis-related groups (DRG) covering, in principle, half of hospital costs, and a basic budget received as a block grant.

The study included 75 high-risk pregnant women. We used a prospective, individual bottom-up method based on: 1) hospital stay and the resources required, 2) operating theatre costs, 3) other major procedures, and 4) material and medication costs. Overhead costs (basic and general costs) were added on the basis on five key variables: 1) number of admittances (length of stay), 2) number of discharges, 3) number of employees, 4) floor space, and 5) number of PCs. The total cost for each patient was compared with the reimbursement received.

We found that the reimbursement did not cover actual costs. Calculations were made for Caesarean and vaginal deliveries respectively: Mean cost of a Caesarean delivery was NOK 96,556, compared to a DRG reimbursement of NOK 47,137; mean cost of a vaginal delivery was NOK 62,136, with a DRG reimbursement of NOK 27,146.