The effects of burn severity and institutional differences on the costs of care

Burn care treatment is among the costliest yet least studied forms of care. This paper presents estimates of the magnitude and components of burn care costs. It analyzes the extent to which burn care cost is determined by severity of burns or by characteristics of the institution in which the patient is treated, based on patient-specific data from eight hospitals representing different levels of technical sophistication in the delivery of burn care. Costs of care are higher in specialized facilities. Many patients with small burns are treated in specialized facilities, at much higher costs than patients treated in general care facilities. Among specialized facilities, patient severity accounts for a portion of the variance in costs, but significant cost differences remain after adjusting for severity. These results suggest that cost-control efforts should concentrate on specifying criteria for admission to specialized burn facilities, regional coordination of facilities and institutions, and improved facilities design and management.