Trade-offs between hospital charges and patient outcomes

The increasing cost of health care has focused attention on the trade-offs between health care expenditures and patient outcomes. In this study, hospital charges were contrasted with the health status at 1 year of follow-up of 549 patients admitted to a university hospital medical service. The findings related to short-term outcomes were consistent with those of other investigators: large expenditures were associated with patients who died in the hospital, especially those whose death was unexpected. Both 1-year survival and hospital charges were found to correlate with physician estimates of illness severity and prognosis at the time of admission. Patients considered not ill with a favorable prognosis had a mortality rate at 1 year of 3%, comprised 7% of the cohort and generated 2% of total charges. In contrast, patients considered severely ill with an unfavorable prognosis had a mortality rate of 65%, comprised 19% of the cohort and generated 30% of total charges. Nevertheless, 46% of the survivors in this latter group were considered to be functional and only mildly ill at 1 year of follow-up. The imprecision of clinical judgements at the time of admission in predicting long-term outcome argues for aggressive management of acutely hospitalized patients when there is any doubt about their prognosis.