title: Microsimulation of financial impact of demand surge on hospitals: the H1N1 influenza pandemic of fall 2009.
abstract: OBJECTIVE
  Microsimulation was used to assess the financial impact on hospitals of a surge in influenza admissions in advance of the H1N1 pandemic in the fall of 2009. The goal was to estimate net income and losses (nationally, and by hospital type) of a response of filling unused hospital bed capacity proportionately and postponing elective admissions (a "passive" supply response).
  
  
  METHODS
  Epidemiologic assumptions were combined with assumptions from other literature (e.g., staff absenteeism, profitability by payer class), Census data on age groups by region, and baseline hospital utilization data. Hospital discharge records were available from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Hospital bed capacity and staffing were measured with the American Hospital Association's (AHA) Annual Survey.
  
  
  RESULTS
  Nationwide, in a scenario of relatively severe epidemiologic assumptions, we estimated aggregate net income of $119 million for about 1 million additional influenza-related admissions, and a net loss of $37 million for 52,000 postponed elective admissions.
  
  
  CONCLUSIONS
  Aggregate and distributional results did not suggest that a policy of promising additional financial compensation to hospitals in anticipation of the surge in flu cases was necessary. The analysis identified needs for better information of several types to improve simulations of hospital behavior and impacts during demand surges.
authors: Wichita-Sedgwick County EMS System Department of Emergency Medicine, University of Kansas Department of Preventive Medicine and Public Health University of Kansas, Wichita, KS, USA.
authors: Sabina
authors: S
authors: Braithwaite
authors: Bernard
authors: B
authors: Friedman
authors: Ryan
authors: R
authors: Mutter
authors: Michael
authors: M
authors: Handrigan
mesh_terms: D000041:Absenteeism; D004196:Disease Outbreaks / Q000191:economics* / Q000517:prevention & control; D004469:Economics, Hospital; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000191:economics* / Q000453:epidemiology; D008505:Medical Staff, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D018803:Models, Economic; D010348:Patient Care Team / Q000191:economics; D055872:Surge Capacity / Q000191:economics*; D014481:United States
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