The use of the transition cost accounting system in health services research.

The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States to calculate the costs of patient care. Our objectives were to review the use of hospital-based cost accounting systems to measure costs of treatment and discuss potential use of the Transition cost accounting system in health services research. Such systems provide internal reports to administrators for formulating major policies and strategic plans for future activities. Our review suggests that the Transition cost accounting information system may useful for estimating in-hospital costs of treatment.

Outcomes and cost of coronary artery bypass graft surgery in the United States and Canada.

BACKGROUND: We sought to determine whether there is a difference in in-hospital outcomes and costs for coronary artery bypass graft surgery (CABG) between the United States and Canada. METHODS: We compared the outcomes and costs of treating 12 017 consecutive patients (4698 US and 7319 Canadian patients) undergoing CABG at 5 US and 4 Canadian hospitals. Participating hospitals used the same cost accounting system to provide patient-level clinical, resource utilization, and cost-of-treatment data (excluding physicians' fees). Canadian costs were converted to US dollars using purchasing power parities. RESULTS: Compared with Canadian patients, US patients were older (mean +/- SD age, 68.0 +/- 10.4 vs 63.7 +/- 9.8 years [P<.001]), more likely to be female (27.4% vs 21.8% [P<.001]), and discharged from the hospital sooner (mean +/- SD length of stay, 8.7 +/- 0.1 vs 9.5 +/- 0.1 days [P<.001]). In-hospital costs of treatment were substantially higher in the United States than in Canada (mean +/- SD cost, dollar 20,673 +/- dollar 241 vs dollar 10,373 +/- dollar 123 [P<.001]; median, dollar 16,036 vs dollar 7880). After controlling for demographic and clinical differences, length of stay in Canada was 16.8% longer than in the United States; there was no difference in in-hospital mortality; and the cost in the United States was 82.5% higher than in Canada (P<.001). CONCLUSIONS: The in-hospital cost of CABG in the United States is substantially higher than in Canada. This difference is due to higher direct and overhead costs in US hospitals, is not explained by demographic or clinical differences, and does not lead to superior clinical outcomes.

In-hospital cost of abdominal aortic aneurysm repair in Canada and the United States.

BACKGROUND: Global health care costs in Canada and the United States have been examined on a macroeconomic level. However, to our knowledge, comparative costs of specific procedures in the 2 countries have not been closely studied. METHODS: To perform a microeconomic comparison of costs of open abdominal aortic aneurysm (AAA) repair, we examined the costs of treating 1057 consecutive patients from 4 Canadian (n = 552) and 6 US (n = 505) hospitals. Participating hospitals used the same cost accounting system that provided demographic, clinical, and cost data (excluding physician's fees) for each patient. Canadian dollar costs were converted to US dollar costs using purchasing power parities. RESULTS: Compared with patients who underwent AAA repair in the United States, Canadian patients were significantly younger (mean +/- SD, 70.2 +/- 10.5 vs 73.3 +/- 8.5 years; P<.001) and were less likely to undergo elective repair (48.5% vs 73.3%; P<.001). The median length of hospital stay was longer in Canada (9.0 vs 7.0 days; P<.001), and mortality rates were similar (12.0% [Canada] vs 9.9% [United States]; P =.29). The mean +/- SEM cost of AAA repair was dollars 15 852 +/- dollars 790 in Canada compared with US dollars 23299 +/- US dollars 1410 in the United States. CONCLUSIONS: The cost of AAA repair is substantially higher in the United States compared with Canada, despite shorter lengths of stay and similar clinical outcomes. The difference in total treatment costs between Canadian and American hospitals was partially attributable to differences in direct costs, but was largely due to differences in overhead costs.