King's College London School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK.
Clin Rehabil. 2012 Mar;26(3):256-63. doi: 10.1177/0269215511417469. Epub 2011 Oct 5.
To determine the range and variation in costs and service characteristics between different levels of specialist neurorehabilitation services in England, and to determine key predictors of service costs.
A retrospective analysis of service costs, staffing and activity levels, with comparison across service types.
Specialist neurorehabilitation services (n = 17) from different areas of England, were divided into three types according to predefined criteria: adult level 1 (tertiary) (n = 8) and level 2a (supra-district) (n = 7) services; and children's services (n = 2).
Annual service costs were collated using a standard costing template, and divided according to principal cost type (direct/indirect/overheads) and behaviour (variable/non-variable). For comparison between the level 1 and 2a services, costs and service characteristics were calculated per occupied bed.
The percentage breakdown of costs was consistent across all three service types, with direct costs making up 83%, indirect 10%, and overheads 7% of total costs. The median variable component ranged from 75 to 76%. Staff pay made up 66% and accounted for 95% of the variance of the total costs in adult services. Level 1 services had higher total staffing costs, mainly reflecting higher therapy staff numbers (z = -2.0, P = 0.05). The median total costs/bed-day were: level 1 £530 (interquartile range (IQR) 435-574) (equivalent to US$860 or €650) and level 2a £402 (US$650 or €459) (IQR 326-451) (z = -2.5, P = 0.009). Children's services cost almost twice that (£1017-1177).
Expected variations in cost are largely due to differences in staff costs. Total staff costs projected by 150% provided a reasonable estimate of total unit costs.
确定英格兰不同级别神经康复专科服务的成本范围和变化，并确定服务成本的关键预测因素。
对服务成本、人员配备和活动水平进行回顾性分析，并对不同服务类型进行比较。
根据预定标准，将来自英格兰不同地区的神经康复专科服务（n=17）分为三种类型：成人一级（三级）（n=8）和二级 a（区以上）（n=7）服务；以及儿童服务（n=2）。
使用标准成本模板收集年度服务成本，并根据主要成本类型（直接/间接/间接费用）和行为（可变/不可变）进行划分。为了比较一级和二级 a 服务，按占用床位计算了成本和服务特征。
所有三种服务类型的成本构成百分比一致，直接成本占 83%，间接成本占 10%，间接费用占 7%。可变部分的中位数范围在 75%到 76%之间。员工薪酬占 66%，占成人服务总成本差异的 95%。一级服务的总人员配备成本较高，主要反映出治疗人员数量较高（z=-2.0，P=0.05）。中位总费用/床日分别为：一级 £530（四分位距（IQR）435-574）（相当于 US$860 或 €650）和二级 a £402（US$650 或 €459）（IQR 326-451）（z=-2.5，P=0.009）。儿童服务的成本几乎是其两倍（£1017-1177）。
预期的成本变化主要是由于员工成本的差异。按 150%预测的总员工成本为总单位成本提供了合理的估计。
