Unit:
Department of NursingLibrary of the School of Health Sciences
Author:
Perdikouri Kalliopi
Dissertation committee:
Θεόδωρος Κατσούλας, Αναπληρωτής Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Γεώργιος Μπαλτόπουλος, Ομότιμος Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Ειρήνη Γραμματοπούλου, Καθηγήτρια, Τμήμα Φυσικοθεραπείας, ΠΑΔΑ
Ελισσάβετ Πατηράκη, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Καϊτελίδου Δάφνη, Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Στυλιανός Κατσαραγάκης, Επίκουρος Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Πέτρος Γαλάνης, Επίκουρος Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Original Title:
Διερεύνηση των παραμέτρων του κόστους και της αποζημίωσης της νοσοκομειακής περίθαλψης των ασθενών τελικού σταδίου
Translated title:
Investigating the parameters of cost and reimbursement for end-of-life hospitalized patients
Summary:
The purpose of the present Dissertation is to investigate the hospital care of Endof-Life (EoL) cancer patients in terms of cost and reimbursement. This kind of care
falls in the field of Palliative Care (PC), the holistic approach, that beyond the
management of patients' symptoms, includes ensuring the quality of life for them and
their families. The hospital environment was initially out of focus of PC due to its
holistic philosophy and the wide evolvement of hospice care. Recently, this has been
overturned due to the need to incorporate hospital services in order to satisfy the
patients’ PC needs more thoroughly. At the same time, the interest has been directed
towards more appropriate classification systems for PC patients and proper
reimbursement of PC services.
In our country, PC patients are estimated to be over 120,000 per year (37% cancer
patients), while the need for hospital beds has been calculated at 500. In absence of
other alternative settings, a significant number of EoL cancer patients are expected to
be hospitalized not only during an acute episode of care.
The present study took place in a ward of internal medicine of a public hospital in
Athens. Prior investigation of the patient casemix in this specific clinic had provided
evidence of the presence of a significant number of cancer patients -and a
corresponding death rate - with a relatively long length of stay. The collection of cost
and reimbursement data for the year 2015, when the study was carried out, confirmed
the initial indications as 271 of the total 375 cases involved a diagnosis of malignant
disease. The final analysis included 135 cases with death discharge status and length
of stay of ≥2 and ≤180 days.
To determine the total cost (payroll excluded), a micro-costing method was
conducted for the calculation of individual cost, while overhead cost was attributed to
patients through main and auxiliary cost centers. The total cost per patient per day
was calculated to be 97±28.88 (min 59.52, max 235.23) euros with equal participation
of individual patient’s and overhead costs. No correlation between individual cost and
diagnosis, age or gender was detected. Length of stay was found to be the only
statistically significant predictor of total cost. The extension of hospitalization by one
day causes an increase in the average cost by 85 euros, which is significantly greater
than the per diem fee of 60 euros.
Reimbursement was performed either by the Greek Diagnosis Related Groups (GrDRGs, KEN) or by the per diem fee. The selection of the assigned DRG was based
mainly on diagnosis. In case that the actual length of stay exceeded the corresponding
prescribed by DRGs, the rest of the days were compensated by per diem charging.
The use of DRGs was associated with a trend of over-reimbursement, especially for
hospitalizations <20 days, while the opposite effect was identified for per diem
charges, especially for hospitalizations >40 days. In the case of the combined use of
the two available reimbursement alternatives, a double cross-subsidization
phenomenon was described, not just between different care events but during the
same hospital stay as well. Currently, neither of the two available reimbursement
methods is considered ideal to compensate for the actual cost.
Any attempt to reform the framework of PC services in the country should take
into mind both cost data and reimbursement alternatives in order to ensure the
sustainability and to avoid phenomena of "reluctance" of institutions to care for such
groups of vulnerable patients.
Main subject category:
Health Sciences
Keywords:
End-of-life care, Diagnosis related groups, Reimbursement methods, Palliative care
Number of references:
276
File:
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Phd_Perdikouri_Kalliopi.pdf
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