Steven A. Finkler

The Distinction Between Cost and Charges

The literature on economic efficiency in providing hospital services has been growing recently. Often such literature examines the costs of providing services at varying volumes of treatments per location per year. However, instead of measuring cost directly, these studies use patient bills (charges) aa a proxy for cost. Charges may bear little resemblance to economic cost, and use of charges as a proxy for economic cost may lead researchers to draw unwarranted conclusions about economic efficiency. Because of the differences between economic cost, accounting cost, and charges to the patient, actual resource consumption should be used as a measure of cost.

A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants

To determine the safety, efficacy, and cost savings of early hospital discharge of very-low-birth-weight infants (less than or equal to 1500 g), we randomly assigned infants to one of two groups. Infants in the control group (n = 40) were discharged according to routine nursery criteria, which included a weight of about 2200 g. Those in the early-discharge group (n = 39) were discharged before they reached this weight if they met a standard set of conditions. For families of infants in the early-discharge group, instruction, counseling, home visits, and daily on-call availability of a hospital-based nurse specialist for 18 months were provided. Infants in the early-discharge group were discharged a mean of 11 days earlier, weighed 200 g less, and were two weeks younger at discharge than control infants. The mean hospital charge for the early-discharge group was 27 percent less than that for the control group (

A randomized trial of early discharge and nurse specialist transitional follow-up care of high-risk childbearing women.

47,520 vs.

Determinants of market share for a hospital's services.

64,940; P less than 0.01), and the mean physicians charge was 22 percent less (

Nursing care delivery models and nurse satisfaction.

5,933 vs.

The case for the use of evidence-based management research for the control of hospital costs.

7,649; P less than 0.01). The mean cost of the home follow-up care in the early-discharge group was

Improved Cost Allocation in Case-Mix Accounting

576, yielding a net saving of

Changing the delivery of nursing care. Implementation issues and qualitative findings.

18,560 for each infant. The two groups did not differ in the numbers of rehospitalizations and acute care visits, or in measures of physical and mental growth. We conclude that early discharge of very-low-birth-weight infants, with follow-up care in the home by a nurse specialist, is safe and cost effective.

Cost Finding for High- Technology, High-Cost Services: Current Practice and a Possible Alternative

In a randomized clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group (N = 52) was discharged routinely from the hospital. The intervention group (N = 44) was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalizations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight (< or = 2,500 g) was three times more prevalent in the control group (29%) than in the intervention group (8.3%). The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44% less than for the control group. The mean cost of the clinical specialist follow-up care was 2% of the total hospital charges for the control group. A net savings of

The cost effects of protocol systems. The marginal cost-average cost dichotomy.

13,327 was realized for each mother-infant dyad discharged early from the hospital.