The type and screen: are patient charges a valid measure of cost reduction?

Previous studies of the type and screen have employed reduction in patient charges as a measure of cost savings. Actual cost reductions were estimated as well as patient charge reductions, for the type and screen in a large university medical center with 38,519 cross-matches and 18,152 red cell containing transfusions (C/T = 2.12) in 1980. If the type and screen had been implemented for elective surgical procedures with C/T greater than 2, the C/T for these services would have fallen from 2.82 to 2.17. If use of the type and screen were extended to obstetrics patients, the total surgical and obstetrical patient charges would be reduced by $51,752, but only $9,232 or less in actual cost reduction would have accrued. The type and screen does not lead to significant decreases in labor or overhead costs which are the largest component of patient charges. Patient charge savings are not a valid measure of actual cost reduction in our setting.