RESUMO
The cost of diagnostic and therapeutic procedures in patients with acute myocardial infarction (AMI) during hospitalization was determined using both the Diagnosis Related Group (DRG) and Process Related Group (PRG) systems. This cost-analysis system was planned and performed to estimate the cost of medical and non-medical staff involved in patient care, as well as commensurate costs. Over a three-month period, 45 patients discharged with a diagnosis of AMI, equivalent to 410 code ICD-9-CM, were enrolled in the study. The collected data were then processed and the cost for each DRG was derived. The mean cost borne for each patient with AMI was 5,864,345 Italian lire with a maximum of 17,138,300 lire for DRG 112 and a minimum of 3,332,329 lire for DRG 123. Our data suggest that in patients with AMI, there is profound discrepancy between the current DRG reimbursements and "real" cost, for example in DRG 112 (a discrepancy equivalent to 166%). The cost difference is essentially related to different procedures involved in medical care and, therefore, it follows that the overall cost of patient with AMI is primarily related to PRG cost and is largely independent of other components. These results prove that therapeutic strategies are very important in determining the cost for each DRG and that the cost for each DRG can change in relation to the PRG performed and to the progression of illness. The utilization of DRG and PRG systems appears to be an essential tool that can be used to build a system in which not only efficiency but also quality of care are evaluated.