与可避免住院相关的直接和间接生产力损失成本。
Direct and lost productivity costs associated with avoidable hospital admissions.
机构信息
Universidade Nova de Lisboa Escola Nacional de Saúde Publica Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal.
Universidade Nova de Lisboa Centro de Investigação em Saúde Publica Lisboa, Lisboa, Portugal.
出版信息
BMC Health Serv Res. 2020 Mar 13;20(1):210. doi: 10.1186/s12913-020-5071-4.
BACKGROUND
Hospitalizations for ambulatory care sensitive conditions are commonly used to evaluate primary health care performance, as the hospital admission could be avoided if care was timely and adequate. Previous evidence indicates that avoidable hospitalizations carry a substantial direct financial burden in some countries. However, no attention has been given to the economic burden on society they represent. The aim of this study is to estimate the direct and lost productivity costs of avoidable hospital admissions in Portugal.
METHODS
Hospitalizations occurring in Portugal in 2015 were analyzed. Avoidable hospitalizations were defined and their associated costs and years of potential life lost were calculated. Direct costs were obtained using official hospitalization prices. For lost productivity, there were estimated costs for absenteeism and premature death. Costs were analyzed by components, by conditions and by variations on estimation parameters.
RESULTS
The total estimated cost associated with avoidable hospital admissions was €250 million (€2515 per hospitalization), corresponding to 6% of the total budget of public hospitals in Portugal. These hospitalizations led to 109,641 years of potential life lost. Bacterial pneumonia, congestive heart failure and urinary tract infection accounted for 77% of the overall costs. Nearly 82% of avoidable hospitalizations were in patients aged 65 years or older, therefore did not account for the lost productivity costs. Nearly 84% of the total cost comes from the direct cost of the hospitalization. Lost productivity costs are estimated to be around €40 million.
CONCLUSION
The age distribution of avoidable hospitalizations had a significant effect on costs components. Not only did hospital admissions have a substantial direct economic impact, they also imposed a considerable economic burden on society. Substantial financial resources could potentially be saved if the country reduced avoidable hospitalizations.
背景
门诊医疗敏感条件下的住院治疗常用于评估初级卫生保健的绩效，因为如果及时、充分地提供医疗服务，就可以避免住院。先前的证据表明，在一些国家，可避免的住院治疗会带来巨大的直接经济负担。然而，人们尚未关注到它们给社会带来的经济负担。本研究旨在估算葡萄牙可避免住院治疗的直接和生产力损失成本。
方法
分析了 2015 年在葡萄牙发生的住院治疗。定义了可避免的住院治疗，并计算了其相关费用和潜在生命损失年数。直接成本是根据官方住院价格获得的。对于生产力损失，估算了旷工和过早死亡的成本。按成本构成、病种和估计参数变化对成本进行了分析。
结果
与可避免住院治疗相关的总估计费用为 2.5 亿欧元（每次住院治疗 2515 欧元），占葡萄牙公立医院总预算的 6%。这些住院治疗导致 109641 人潜在生命损失年数。细菌性肺炎、充血性心力衰竭和尿路感染占总费用的 77%。近 82%的可避免住院治疗发生在 65 岁或以上的患者中，因此未计入生产力损失成本。近 84%的总费用来自住院治疗的直接费用。预计生产力损失成本约为 4000 万欧元。
结论
可避免住院治疗的年龄分布对成本构成有显著影响。住院治疗不仅对经济造成了重大的直接影响，也给社会带来了相当大的经济负担。如果该国减少可避免的住院治疗，可能会节省大量的财政资源。
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