Related Experiment Videos
[Treatment aspects of unstable angina. Costs and payments for DRG]
C Brunelli1, P Spallarossa, A Pasdera
1Dipartimento di Medicina Interna, Università degli Studi, Genova.
Insights
This study analyzed the costs of treating unstable angina (UA) and found significant discrepancies between actual medical expenses and Diagnosis Related Groups (DRG) reimbursements, highlighting the need for resource optimization in cardiology care.
Area of Science:
- Cardiology
- Health Economics
- Healthcare Management
Context:
- Unstable angina (UA) admissions are increasing, surpassing myocardial infarction rates.
- Growing economic pressures necessitate cost-effective healthcare strategies.
- Current clinical management of UA requires re-evaluation through health-cost accounting.
Purpose:
- To examine the current management protocols for patients with unstable angina.
- To prospectively calculate the actual medical costs associated with unstable angina care.
- To compare real healthcare costs with Diagnosis Related Groups (DRG) reimbursement.
Summary:
- A prospective study recorded cardiac procedures and associated times for 53 unstable angina patients across four DRGs.
- Costs were calculated based on salaries, supplies, equipment, and indirect expenses.
- Mean costs varied significantly by DRG, with procedures driving higher expenses (e.g., DRG 112 with angioplasty costing 12,751,454 Liras).
Impact:
- Identified a substantial discrepancy between the true cost of unstable angina care and current DRG reimbursement rates.
- Emphasizes the need for accurate cost analysis to optimize resource allocation and improve healthcare benefits.
- Provides foundational data for refining financial strategies in managing unstable angina patients.
Abstract:
Patients with unstable angina fall into a wide prognostic and therapeutic spectrum but, in general, have great access to specialty care and invasive procedures. In the modern era, in which admissions for unstable angina outnumber those for myocardial infarction, and growing economic pressures are placed on health care systems, cardiologists must re-examine clinical strategies for treating unstable angina in the light of health-cost accounting. The aims of the present study were to examine the current management of patients admitted to our cardiology department and to calculate the medical costs. A patient schedule was drawn up to prospectively register the number and type of cardiac processes carried out during hospitalization for all unstable angina patients in the period between March 1st and May 30th, 1995. Time (minutes) actually spent by both physicians and nurses for each cardiac process were carefully recorded in order to calculate the activity budget. The effective economic budget was built for each cardiac process taking into account salaries, consumable supplies, equipment service contracts, depreciation and indirect medical and non medical costs for CCU and ward. Based to the Diagnosis Related Groups (DRG) system, 53 out of 318 patients (16%) were admitted with documented or suspected unstable angina and allocated to discharge into four DRGs: DRG 140-medically treated unstable angina: 18 patients; DRG 124-unstable angina with angiography: 16 patients; DRG 122-unstable angina evolving in myocardial infarction: 6 patients; DRG 112-unstable angina with angioplasty: 13 patients. The mean cost for hospitalized patient with unstable angina was 5,574,958 Italian Liras (DRG 140 = 2,687,719; DRG 124 = 2,800,347; DRG 122 = 6,086,563; DRG 112 = 12,751,454). The difference in costs was essentially related to the procedures involved in medical care, DRGs with expensive cardiac processes having higher costs. Furthermore, these data show a deep discrepancy between "real" costs and current DRG reimbursement. In conclusion, data show the standard management of unstable angina at our center; calculating the true costs of unstable angina is the first step towards maximizing resources and optimizing benefits.