Financial expenditures for the care of cerebrovascular disease patients in an urban setting.

A study was undertaken to determine the magnitude of the charges and costs and the sources of reimbursements for the care of cerebrovascular disease (CVD) patients in an urban setting, Orleans Parish (County), Louisiana, in 1971. The study helps to put national data on the cost-burden of cerebrovascular disease into perspective at the community level. It is thought that such data may prove useful in planning and evaluation of intervention programs and more coordinated approaches to care. All hospitals, nursing homes, extended care facilities, and noninstitutional sources of care (home health and rehabilitation agencies) that were identified as providing services to CVD patients were invited to participate in the study, and a sample of such cases was selected from each participating facility. The billing records for these cases were then reviewed and analyzed to determine charges by category of service and sources of reimbursement. At government institutions, per diem rates were used to determine costs. Total charges for care of the CVD patients amounted to $6,070,000. Hospital care generated the major charge, amounting to $5,159,000 (85 percent of the total charges) during the study year. Nursing home care charges totaled $391,000 (6.5 percent), extended care services $373,000 (6.1 percent), and home health care and noninstitutional rehabilitation services $147,000 (2.4 percent). Analysis of the data according to type of service revealed that only a small percentage of the care dollar was spent for rehabilitation services. The greatest amounts were spent for room and board in institutional facilities and for drugs, diagnostic services, and miscellaneous other services in hospitals. Average expenditures per CVD case for rehabilitation services in institutions were highest in extended care facilities, being much lower in hospitals and negligible in nursing homes. Average expenditures for care by noninstitutional health service agencies were highest for home aide services, followed by nursing and rehabilitation services.