Macario A, Vitez T S, Dunn B, McDonald T
Department of Anesthesia, Stanford University School of Medicine, California 94305-5115, USA.
Anesthesiology. 1995 Dec;83(6):1138-44. doi: 10.1097/00000542-199512000-00002.
Many health-care institutions are emphasizing cost reduction programs as a primary tool for managing profitability. The goal of this study was to elucidate the proportion of anesthesia costs relative to perioperative costs as determined by charges and actual costs.
Costs and charges for 715 inpatients undergoing either discectomy (n = 234), prostatectomy (n = 152), appendectomy (n = 122) or laparoscopic cholecystectomy (n = 207) were retrospectively analyzed at Stanford University Medical Center from September 1993 to September 1994. Total hospital costs were separated into 11 hospital departments. Cost-to-charge ratios were calculated for each surgical procedure and hospital department. Hospitalization costs were also divided into variable and fixed costs (costs that do and do not change with patient volume). Costs were further partitioned into direct and indirect costs (costs that can and cannot be linked directly to a patient).
Forty-nine (49%) percent of total hospital costs were variable costs. Fifty-seven (57%) percent were direct costs. The largest hospital cost category was the operating room (33%) followed by the patient ward (31%). Intraoperative anesthesia costs were 5.6% of the total hospital cost. The overall cost-to-charge ratio (0.42) was constant between operations. Cost-to-charge ratios varied threefold among hospital departments. Patient charges overestimated resource consumption in some hospital departments (anesthesia) and underestimated resource consumption in others (ward).
Anesthesia comprises 5.6% of perioperative costs. The influence of anesthesia practice patterns on "downstream" events that influence costs of hospitalization requires further study.
许多医疗机构将成本削减计划作为管理盈利能力的主要手段。本研究的目的是阐明根据收费和实际成本确定的麻醉成本相对于围手术期成本的比例。
对1993年9月至1994年9月在斯坦福大学医学中心接受椎间盘切除术（n = 234）、前列腺切除术（n = 152）、阑尾切除术（n = 122）或腹腔镜胆囊切除术（n = 207）的715例住院患者的成本和收费进行回顾性分析。医院总成本分为11个医院科室。计算每个手术和医院科室的成本收费比。住院成本也分为可变成本和固定成本（随患者数量变化和不变化的成本）。成本进一步分为直接成本和间接成本（可直接与患者相关联和不能直接与患者相关联的成本）。
医院总成本的49%为可变成本。57%为直接成本。最大的医院成本类别是手术室（33%），其次是患者病房（31%）。术中麻醉成本占医院总成本的5.6%。手术间的总体成本收费比（0.42）保持不变。各医院科室的成本收费比相差三倍。在一些医院科室（麻醉科）患者收费高估了资源消耗，而在其他科室（病房）则低估了资源消耗。
麻醉占围手术期成本的5.6%。麻醉实践模式对影响住院成本的“下游”事件的影响需要进一步研究。
