RESUMEN
BACKGROUND: Image guidance for shunt surgery results in more accurate proximal catheter placement. However, reduction in shunt failure remains unclear in the literature. There have been no prior studies evaluating the cost effectiveness of neuronavigation for shunt surgery. OBJECTIVE: To perform a cost analysis using available hospital charges of hypothetical shunt surgery performed with/without electromagnetic neuronavigation (EMN). METHODS: Hospital charges were collected for physician fees, radiology, operating room (OR) time and supplies, postanesthesia care unit, hospitalization days, laboratory, and medications. Index shunt surgery charges (de novo or revision) were totaled and the difference calculated. This difference was compared with hospital charges for shunt revision surgery performed under 2 clinical scenarios: (1) same hospital stay as the index surgery; and (2) readmission through the emergency department. RESULTS: Costs for freehand de novo and revision shunt surgery were $23 946.22 and $23 359.22, respectively. For stealth-guided de novo and revision surgery, the costs were $33 646.94 and $33 059.94, a difference of $9700.72. The largest charge increase was due to additional OR time (34 min; $4794), followed by disposable EMN equipment ($2672). Total effective charges to revise the shunt for scenarios 1 and 2 were $34 622.94 and $35 934.94, respectively. The cost ratios between the total revision charges for both scenarios and the difference in freehand vs EMN-assisted shunt surgery ($9700.72) were 3.57 and 3.70, respectively. CONCLUSION: From an economic standpoint and within the limitations of our models, the number needed to prevent must be 4 or less for the use of neuronavigation to be considered cost effective.
Asunto(s)
Precios de Hospital , Hidrocefalia/economía , Hidrocefalia/cirugía , Tomografía Computarizada por Rayos X/economía , Derivación Ventriculoperitoneal/economía , Femenino , Precios de Hospital/tendencias , Humanos , Hidrocefalia/diagnóstico por imagen , Imágenes en Psicoterapia/economía , Imágenes en Psicoterapia/tendencias , Tiempo de Internación/economía , Tiempo de Internación/tendencias , Masculino , Neuronavegación/economía , Neuronavegación/tendencias , Quirófanos/economía , Quirófanos/tendencias , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/tendencias , Derivación Ventriculoperitoneal/tendenciasRESUMEN
Objective The study looked at the impact that the switch from a reimbursement system with hospital per diem charges to a regional budget had on treatment. Methods Routine data from two clinics over a period of ten years were evaluated. Results Treatment took place in day clinics and on an outpatient basis to an increased extent after the change. Conclusion The change in reimbursement system was the cause of the change in treatment. Since similar effects can also be expected when switching from the new reimbursement system for psychiatry and psychosomatic medicine to a regional budget system, regional budgets are a reasonable alternative.
Asunto(s)
Atención Ambulatoria/economía , Presupuestos/tendencias , Centros de Día/economía , Precios de Hospital/tendencias , Trastornos Mentales/economía , Servicio de Psiquiatría en Hospital/economía , Mecanismo de Reembolso/economía , Adulto , Atención Ambulatoria/tendencias , Ahorro de Costo/tendencias , Centros de Día/tendencias , Femenino , Predicción , Alemania , Humanos , Tiempo de Internación/economía , Tiempo de Internación/tendencias , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Persona de Mediana Edad , Servicio de Psiquiatría en Hospital/tendencias , Regionalización/tendencias , Mecanismo de Reembolso/tendenciasAsunto(s)
Competencia Económica , Economía Hospitalaria , Costos de la Atención en Salud/tendencias , Precios de Hospital/tendencias , Seguro de Salud/economía , Prestación Integrada de Atención de Salud , Reforma de la Atención de Salud , Gastos en Salud , Clausura de las Instituciones de Salud , Costos de Hospital , Comercialización de los Servicios de Salud , Modelos Económicos , Estados UnidosRESUMEN
Hospital mergers, like Godzilla's comeback movie, promise that bulk means marketplace brawn. Yet as the dust settles, the payoff isn't always so clear. Promised efficiencies from merging duplicated programs--even shutting down entire hospitals--often fail to materialize. In fact, cutting the deal may turn out to be the easy part.