title: Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model.
abstract: BACKGROUND
  Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems.
  
  
  METHODS
  A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established.
  
  
  RESULTS
  The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS).
  
  
  CONCLUSIONS
  Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.
authors.affiliation: Medical Directorate, University Hospital Zurich, Switzerland.
authors.forename: Tarun
authors.initials: T
authors.lastname: Mehra
authors.affiliation: Department of Plastic Surgery, Helsinki University and Helsinki University Hospital, Finland.
authors.forename: Virve
authors.initials: V
authors.lastname: Koljonen
authors.affiliation: Department of Biostatistics, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Medical Directorate, University Hospital Zurich, Switzerland.
authors.forename: Jörk
authors.initials: J
authors.lastname: Volbracht
authors.affiliation: Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Giovanoli
authors.affiliation: Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Plock
authors.affiliation: Medical Directorate, University Hospital Zurich, Switzerland.
authors.forename: Rudolf Maria
authors.initials: RM
authors.lastname: Moos
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000191:economics*; D002648:Child; D002985:Clinical Protocols; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D011445:Prospective Payment System / Q000191:economics*; D012189:Retrospective Studies; D013557:Switzerland; D015599:Trauma Severity Indices; D055815:Young Adult