[Ongoing health management control by cost monitoring through tracer indicators].
OBJECTIVE
To determine the operational cost of a hospital's surgical unit, compare those results with standards, and determine the incidence of the costs; to produce an effective methodology for this purpose that can be applied to all kinds of medical units using any low-cost widely available computer database system, with that methodology being utilized for ongoing management control.


METHODS
This study was carried out in 1999 in the Orthopedics and Traumatology Unit of the "Domingo Funes" Public Hospital, in the province of Córdoba, Argentina. Of the 817 patients who underwent diagnostic or therapeutic procedures in that unit during the year, we selected the 154 of them who were hospitalized and required surgical or instrumental procedures. The study used the tracer event method described by Kessner. Through a consensus process, medical specialists and health economists selected and defined these indicators, which were categorized in relation to their complexity (high, medium, limited, or none). Direct and indirect costs were assessed in order to study their contribution to total cost. Total cost was estimated using nine variables that were applied to the different tracer events.


RESULTS
The largest portion of total cost, both real and standard, was based on the "bed-day" variable. Of this bed-day cost for all tracer events, 51.2% was due to an indirect cost of "social hospitalization" (keeping patients hospitalized for such reasons as transportation difficulties or delays in receiving requested medical supplies) and 48.8% to a direct cost of true therapeutic hospitalization. This bed-day cost was 117% higher for the real costs as compared to the standard costs. The indirect costs of social hospitalization and of therapeutic supplies made up nearly half of the total real cost. Excluding the indirect costs, the real cost of all the tracer events exceeded the standard cost by only 6.4%. Including the indirect costs of social hospitalization and of therapeutic supplies, the real cost exceeded the standard cost by 39.8%. The amount spent on medical staff and support personnel represented just 11.5% of the total cost.


CONCLUSIONS
Suggestions are provided in various areas, including solutions for the high cost of social hospitalization and therapeutic supplies, the cost-control benefits of creating protocols for procedures and treatments, and the rational utilization of technology in order to improve efficiency and reduce risks. The wider application of this procedure is recommended for cost-management control in all hospital units carrying out surgery or other medical procedures.
Villanueva
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Escuela de Salud Pública, Universidad Nacional de Córdoba, Hospital Estatal Domingo Funes, Córdoba, Argentina. villanueva@powernet.net.ar
D001118:Argentina; D003363:Cost Control; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans