The use of in-hospital physician services for acute myocardial infarction. Changes in volume and complexity over time
E Sawitz1, J A Showstack, J Chow
1Institute for Health Policy Studies, San Francisco, CA 94143-0936.
Insights
Hospital resource use for acute myocardial infarction patients changed significantly from 1972 to 1982. Despite shorter stays, physician costs and services more than doubled, driven by new technologies and procedures.
Area of Science:
- Cardiology
- Health Services Research
- Health Economics
Background:
- Acute myocardial infarction (AMI) management has evolved.
- In-hospital resource utilization patterns require ongoing analysis.
Purpose of the Study:
- To analyze changes in in-hospital service use for AMI patients between 1972 and 1982.
- To assess the impact of evolving medical practices on healthcare costs.
Main Methods:
- Study included 164 patients admitted with AMI.
- Resource use measured in constant 1982 dollars, adjusted for clinical severity.
- Compared service utilization and costs between 1972 and 1982.
Main Results:
- Average length of hospital stay decreased by nearly 40%.
- Physician services doubled, and total physician costs nearly tripled.
- Increased physician costs attributed to complex diagnostics and coronary artery bypass graft surgery.
Conclusions:
- Hospital cost containment may shift cost increases to physicians.
- Introduction of new diagnostic and therapeutic services drives physician cost escalation.
- Outpatient care expansion may influence future cost trends.
Abstract:
Changes between 1972 and 1982 in the use of in-hospital services were studied for 164 patients admitted with acute myocardial infarction. Resource use was measured in constant 1982 dollars adjusted for differences in clinical severity of the patients. Although average length of stay decreased by almost 40% during this period, the number of physician services doubled and total physician costs increased almost threefold. The increase in physician costs was due primarily to the use of complex diagnostic technologies and to the provision of coronary artery bypass graft surgery. The results of this study suggest that as hospital costs are constrained by prospective payment, physician costs may continue to rise as new diagnostic and therapeutic services are introduced into practice and as more care is shifted to the outpatient setting.
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