title: A comparison of hospital costs with reimbursement received for patients undergoing the Norwood procedure for hypoplasia of the left heart.
abstract: OBJECTIVE
  To determine whether the present system of reimbursement, based on diagnosis-related groups and regular financial budgeting, covers the costs incurred during hospitalisation of 7 children undergoing the three stages of the Norwood sequence for surgical treatment of hypoplastic left heart syndrome.
  
  
  METHODS
  Between January and September 2003, 7 patients underwent initial surgical palliation with the Norwood procedure at the Rikshospitalet University Hospital. A prospective methodology was developed by our group to measure the costs associated with each individual patient. The patients were closely observed, and the relevant data was collected during their stay in hospital. The stay was divided into four different periods of requirements of resources, defined as heavy intensive care, light intensive care, intermediate care, and ordinary care. At each stage, we recorded the number of staff involved and the duration of surgery and other major procedures, as well as the cost of pharmaceuticals and other consumables. Based on these data, we calculated the cost for each patient. These costs were compared with the corresponding revenue received by the hospital for each of the patients.
  
  
  RESULTS
  We found the total mean cost for the three stages of the Norwood sequence was 138,934 American dollars, while the corresponding revenue received by the hospital was 43,735 American dollars. During this period, one patient died during the first stage of the Norwood sequence.
  
  
  CONCLUSIONS
  Our study shows that steps involved in the Norwood sequence are low-volume but high-cost procedures. The reimbursement received by our hospital for the procedures was less than one-third of the recorded costs.
authors.affiliation: Hospital Management/Health Professional Support Department, Rikshospitalet University Hospital, Oslo, Norway. vinod.mishra@rikshospitalet.no
authors.forename: Vinod
authors.initials: V
authors.lastname: Mishra
authors.forename: Harald
authors.initials: H
authors.lastname: Lindberg
authors.forename: Egil
authors.initials: E
authors.lastname: Seem
authors.forename: Ingrid
authors.initials: I
authors.lastname: Klokkerud
authors.forename: Britt
authors.initials: B
authors.lastname: Fredriksen
authors.forename: Oyvind
authors.initials: O
authors.lastname: Skraastad
authors.forename: Anna
authors.initials: A
authors.lastname: Ostlie
authors.forename: Sølvi
authors.initials: S
authors.lastname: Andresen
authors.forename: Stein
authors.initials: S
authors.lastname: Vaaler
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000191:economics* / Q000379:methods; D005260:Female; D017721:Hospital Costs; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000191:economics / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D009664:Norway