Seringa Joana, Pedreiras Sérgio, Freitas Maria João, Valente de Matos Rosa, Rocha João, Millett Christopher, Santana Rui
Centro Hospitalar Universitário de Lisboa Central, E.P.E., Lisbon, Portugal.
NOVA National School of Public Health, Universidade NOVA Lisboa, Lisbon, Portugal.
Port J Public Health. 2022 Apr 19;40(1):26-34. doi: 10.1159/000524368. eCollection 2022 Apr.
The COVID-19 pandemic has posed greater financial pressure on health systems and institutions that had to respond to the specific needs of COVID-19 patients while ensuring the safety of the diagnosis and treatment of all patients and healthcare professionals. To assess the financial impact of COVID-19 patients admitted to hospitals, we have characterized the cost of COVID-19 admissions, using inpatient data from a Portuguese Tertiary Care University Centre.
We analysed inpatient data from adult patients diagnosed with COVID-19 who were admitted between March 1, 2020 and May 31, 2020. Admissions were eligible if the ICD-10-CM principal diagnosis was coded U07.1. We excluded admissions from patients under 18 years old, admissions with incomplete records, admissions from patients who had been transferred to or from other hospitals or those whose inpatient stay was under 24 h. Pregnancy, childbirth, and puerperium admissions were also excluded, as well as admissions from patients who had undergone surgery.
We identified 223 admissions of patients diagnosed with COVID-19. Most were men (64.1%) and aged 45-64 years (30.5%). Around 13.0% of patients were admitted to intensive care units and 9.9% died in hospital. The average length of hospital stay was 12.7 days (SD = 10.2) and the average estimated cost per admission was EUR 8,177 (SD = 11,534), which represents more than triple the inpatient base price (EUR 2,386). Human resources accounted for the highest proportion of the total costs per admission (50.8%). About 92.4% of the admissions were assigned to Diagnosis Related Group (DRG) 723, whose inpatient price is lower than COVID-19 inpatient costs for all degrees of severity.
COVID-19 admissions represent a substantial financial burden for the Portuguese NHS. For each COVID-19 hospitalized patient it would have been possible to treat three other hospitalized patients. Also, the price set for DRG 723 is not adjusted to the cost of COVID-19 patients. These findings highlight the need for additional financial resources for the health system and, in particular, for hospitals that have treated high volumes of hospitalized patients diagnosed with COVID-19.
新冠疫情给卫生系统和机构带来了更大的财政压力，这些系统和机构在确保所有患者及医护人员诊断和治疗安全的同时，还必须应对新冠患者的特殊需求。为评估收治新冠患者对医院造成的财政影响，我们利用葡萄牙一家三级护理大学中心的住院患者数据，对新冠住院病例的费用进行了分析。
我们分析了2020年3月1日至2020年5月31日期间收治的确诊为新冠的成年患者的住院数据。如果国际疾病分类第十次修订本临床修订版（ICD-10-CM）的主要诊断编码为U07.1，则该病例符合纳入标准。我们排除了18岁以下患者的住院病例、记录不完整的病例、转至或转出其他医院患者的住院病例以及住院时间不足24小时患者的住院病例。妊娠、分娩和产褥期住院病例以及接受过手术患者的住院病例也被排除。
我们确定了223例确诊为新冠的患者住院病例。大多数为男性（64.1%），年龄在45 - 64岁之间（30.5%）。约13.0%的患者被收入重症监护病房，9.9%的患者在医院死亡。平均住院时间为12.7天（标准差 = 10.2），每次住院的平均估计费用为8177欧元（标准差 = 11534），这是住院基础价格（2386欧元）的三倍多。人力资源在每次住院的总成本中占比最高（50.8%）。约92.4%的住院病例被归入诊断相关分组（DRG）723，该分组的住院价格低于所有严重程度的新冠住院病例费用。
新冠住院病例给葡萄牙国民医疗服务体系带来了沉重的财政负担。每收治一名新冠住院患者，原本可以治疗另外三名住院患者。此外，DRG 723设定的价格未根据新冠患者的费用进行调整。这些发现凸显了卫生系统，特别是收治大量确诊为新冠的住院患者的医院需要额外财政资源。
