Iorio R, Healy W L, Richards J A
Department of Orthopedic Surgery, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
Orthopedics. 1999 Feb;22(2):185-9. doi: 10.3928/0147-7447-19990201-07.
This study compared the hospital cost of primary and revision total hip arthroplasty (THA) after the introduction of cost-containment programs (clinical pathway, hip implant standardization, and competitive bid purchasing of hip implants). Hospital financial records for 290 primary and 85 revision THAs performed from October 1993 through September 1995 were analyzed. A cost-accounting system provided actual hospital cost data for each procedure. Accurate calculation of hospital income or loss was determined. Average hospital length of stay was 4.9 days for primary THA and 5.9 days for revision THA. Average hospital cost was $11,104 for primary THA and $14,935 for revision THA. Average net income (hospital revenue hospital expense) for primary THA was $2486. Average loss from revision THA was $401. The payer mix included commercial insurance, Blue Cross/Blue Shield, managed care, Medicare, Medicaid, and workmen's compensation. For primary THA, all payers were profitable except Medicaid and selected managed care contracts. For revision THA, profit was achieved with payment from commercial insurance only. Despite the introduction of cost-containment programs, revision THA did not achieve profitability at our institution.
本研究比较了在引入成本控制项目（临床路径、髋关节植入物标准化以及髋关节植入物竞争性招标采购）后初次全髋关节置换术（THA）和翻修全髋关节置换术的医院成本。分析了1993年10月至1995年9月期间进行的290例初次THA和85例翻修THA的医院财务记录。一个成本核算系统提供了每个手术的实际医院成本数据。确定了医院收入或损失的准确计算。初次THA的平均住院时间为4.9天，翻修THA为5.9天。初次THA的平均医院成本为11,104美元，翻修THA为14,935美元。初次THA的平均净收入（医院收入减去医院费用）为2486美元。翻修THA的平均亏损为401美元。付款方组合包括商业保险、蓝十字/蓝盾、管理式医疗、医疗保险、医疗补助和工人赔偿。对于初次THA，除了医疗补助和选定的管理式医疗合同外，所有付款方都有盈利。对于翻修THA，只有商业保险付款才能实现盈利。尽管引入了成本控制项目，但在我们机构翻修THA并未实现盈利。
