Distribution of emergency department costs.
OBJECTIVE
To report the distribution of emergency department costs by category of expense and level of patient urgency.


METHODS
Cost-to-charge and relative-value methods were used to determine direct and indirect physician, facility, supply, pharmacy, laboratory, radiology, and miscellaneous costs for 24,010 ED patients. Explicit criteria were used to classify patient visits as nonurgent, semiurgent, or urgent.


RESULTS
For all patients, the average costs were physician, $64; facility, $84; laboratory, $21; radiology, $24, and total, $209. Laboratory and radiology costs accounted for 5% of the total costs for nonurgent visits and 23% of the total costs for urgent visits.


CONCLUSIONS
The distribution of ED costs varies significantly according to the urgency of the medical condition. For nonurgent patient visits, most costs are represented by the hospital facility and ED physicians' costs. Ancillary services represent a much greater proportion of costs for patients with urgent conditions. Although reduced test-ordering might result in some savings among patients with urgent conditions, overall improved cost efficiency can be achieved only through reductions in the fixed costs of operation of hospital EDs.
Williams
R M
RM
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, USA.
D000720:Ancillary Services, Hospital / Q000191:economics; D003363:Cost Control; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D008824:Michigan; D012494:Sampling Studies