title: A comparison of actual cost, DRG-based cost, and hospital reimbursement for liver transplant patients.
abstract: The financing of health care services in Norway has been changed from a system of global budgeting to a system partly based on Diagnosis-Related Groups (DRG). The government has decided to derive a part of the hospital revenue from DRG-based, per-patient financing. The aim of this study is to determine whether the present remuneration system covers the actual hospital expenses of liver transplant patients, and whether the present method of calculating DRG-costs is adequate for our institution. Our group developed a prospective method of determining the actual cost per patient. We closely observed and collected the data of eight liver transplant patients during their hospital stay. We divided each of the patients' resource requirements into four categories; heavy intensive care, light intensive care, intermediate care, and ordinary care. In addition, we recorded the number of staff involved, the duration of surgery, the major procedures, and the medical- and material costs. The actual cost of each patient was calculated, based on these data. The actual cost was compared with the corresponding hospital remuneration for each patient. Median cost for liver transplantation was NOK 536.785 (range: NOK 295.113-NOK 844.345) (1$=7,5 NOK), while the corresponding hospital refund was NOK 457.785 (range: NOK 436.465-NOK 483.040). The difference is not statistically significant ( P=0.2). The average 100% DRG-based cost of a liver transplantation was NOK 730.321, which is significantly higher than the actual cost ( P=0.02). The hospital's reimbursement for liver transplantation did not differ significantly from the actual registered cost. The computed cost was significantly lower than the DRG-based cost.
authors.affiliation: Department of Anaesthesiology, University Hospital, Sognsvannsv. 20, 0027 Oslo, Norway. bjorn.skeie@vas.no
authors.forename: Bjorn
authors.initials: B
authors.lastname: Skeie
authors.forename: Vinod
authors.initials: V
authors.lastname: Mishra
authors.forename: Stein
authors.initials: S
authors.lastname: Vaaler
authors.forename: Einar
authors.initials: E
authors.lastname: Amlie
mesh_terms: D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D004469:Economics, Hospital; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016031:Liver Transplantation / Q000191:economics*; D009664:Norway; D009741:Nursing Staff, Hospital / Q000191:economics; D012051:Reimbursement Mechanisms