Page Katie, Barnett Adrain G, Graves Nicholas
Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld, 4059, Australia.
BMC Health Serv Res. 2017 Feb 14;17(1):137. doi: 10.1186/s12913-017-2079-5.
Decreasing hospital length of stay, and so freeing up hospital beds, represents an important cost saving which is often used in economic evaluations. The savings need to be accurately quantified in order to make optimal health care resource allocation decisions. Traditionally the accounting cost of a bed is used. We argue instead that the economic cost of a bed day is the better value for making resource decisions, and we describe our valuation method and estimations for costing this important resource.
We performed a contingent valuation using 37 Australian Chief Executive Officers' (CEOs) willingness to pay (WTP) to release bed days in their hospitals, both generally and using specific cases. We provide a succinct thematic analysis from qualitative interviews post survey completion, which provide insight into the decision making process.
On average CEOs are willing to pay a marginal rate of $216 for a ward bed day and $436 for an Intensive Care Unit (ICU) bed day, with estimates of uncertainty being greater for ICU beds. These estimates are significantly lower (four times for ward beds and seven times for ICU beds) than the traditional accounting costs often used. Key themes to emerge from the interviews include the importance of national funding and targets, and their associated incentive structures, as well as the aversion to discuss bed days as an economic resource.
This study highlights the importance for valuing bed days as an economic resource to inform cost effectiveness models and thus improve hospital decision making and resource allocation. Significantly under or over valuing the resource is very likely to result in sub-optimal decision making. We discuss the importance of recognising the opportunity costs of this resource and highlight areas for future research.
缩短住院时间从而腾出医院床位，是一项重要的成本节约措施，常用于经济评估。为了做出最佳的医疗资源分配决策，需要准确量化这些节约的成本。传统上使用床位的会计成本。相反，我们认为床位日的经济成本对于资源决策更具价值，并且我们描述了用于计算这一重要资源成本的估值方法和估计值。
我们进行了一项条件估值，利用澳大利亚37位首席执行官（CEO）愿意为在其医院释放床位日支付的金额，包括总体情况和特定案例。在调查完成后，我们对定性访谈进行了简要的主题分析，以深入了解决策过程。
平均而言，CEO们愿意为普通病房床位日支付216美元的边际价格，为重症监护病房（ICU）床位日支付436美元，ICU床位的不确定性估计更大。这些估计值明显低于（普通病房床位为四倍，ICU床位为七倍）通常使用的传统会计成本。访谈中出现的关键主题包括国家资金和目标的重要性及其相关的激励结构，以及不愿将床位日作为一种经济资源来讨论。
本研究强调了将床位日作为一种经济资源进行估值对于为成本效益模型提供信息从而改善医院决策和资源分配的重要性。对该资源的估值明显过低或过高很可能导致决策次优。我们讨论了认识到该资源机会成本的重要性，并突出了未来研究的领域。
