PATIENT LENGTH OF STAY AND PAYMENT

Patient Length of Stay and Payment



Patient Length of Stay and Payment

Introduction

CVD (cardiovascular disease) is a common and costly medical condition in all populations. It is the leading cause of death worldwide. Nearly 3.8 million men and 3.4 million women worldwide die each year from coronary heart disease. CVD causes over 4.35 million deaths in Europe and over 1.9 million deaths in the European Union (EU) each year. Nearly half of all deaths in Europe (49%) and the EU (42%) arise from CVD. It is the main cause of years of life lost from early death in Europe and the EU. A third of the years of life lost from early death result from CVD. Overall CVD is estimated to cost the EU economy 169 billion Euros annually of which approximately 62% is due to health care expenses, 21% due to productivity losses and 17% due to informal care of people with CVD. In Switzerland CVD is the most frequent cause of death. It affects 42% of women and 35% of men and accounts for 38% of all deaths (Kaul, 2004).

Between 1999 and 2002 more than 186 out of 100.000 inhabitants annually died from CVD [2]. According to the International Classification of Diseases (ICD-10), 135.341 patients suffering from CVD had been treated in Switzerland in 2004. CVD accounted for 3.1% of all hospital diagnoses in 2004 in Switzerland. With 1.258391 in hospital care days CVD is within the top three ranking of ICD related national hospital stay. The expenditures for inpatient treatment are expected to rise from more than 25 million CHF (16.13 million Euros) in 2005 to more than 27 million CHF (17.42 million Euros) in 2007.

Among the countries in the Organisation for Economic Co-operation and Development (OECD), Switzerland ranks second (11.5%) behind the USA (15%) in terms of healthcare expense versus gross domestic product (GPD). Switzerland (8 days) also ranks second behind Germany (9 days) in terms of length of hospital stay. The increasing health care budget draws public interest to significant economic impacts on the Swiss health care system. ACS (acute coronary syndrome) is a continuum of acute ischemic cardiac conditions. ACS is defined as non-STsegment elevation myocardial infarction (NONSTEMI), STsegment elevation myocardial infarction (STEMI), and unstable angina (UA). Only a few studies have compared the medical costs of ACS from a European perspective, and involve only a small non-representative number of Swiss data.

None of these studies identifies the main causes of expenses in patients suffering from ACS within a nationwide multicenter database of the Swiss population. Analysis of factors that increase or decrease the length of hospital stay of patients with underlying myocardial infarction is of interest from both a medical quality and pecuniary standpoint. The implementation of DRGs will allow nationwide comparative assessments of resource use and costs. The amount of money spent in CVD will be of particular importance (Gandjour, 2002).

The DRG system fixes the amount of treatment on the basis of discharge ...