[Possibilities in the surgical treatment of simple abdominal hernias at polyclinics]

The article deals with questions of organization and treatment of patients with hernias of the abdomen under conditions of polyclinic. 27 operations were performed on 23 patients for the hernia disease. There were no complications. The operations were endured well and the patients returned to their work. The average time of disability was 24 days.

Ambulatory herniorrhaphy under local anesthesia in a community hospital

Four hundred groin hernias were repaired under local anesthesia over a 5 1/2 year period. Eighty-two percent of the patients were discharged on the same day of operation and 12 percent within 24 hours. In 60 percent of these patients, knitted polypropylene mesh (Marlex) was used to reinforce the inguinal floor. There were two infections in this series and other postoperative complications were minimal. Most of the patients returned to their full-time occupations in 4 to 6 weeks. The saving in hospital beds and cost was profound. The follow-up results, although not 100 percent complete, are very encouraging and suggest that this method can be appropriately and safely used by surgeons working in community hospitals.

Improved cost allocation in case-mix accounting

Traditionally, many hospital costs have been allocated to patients using indirect measures that do not always reflect the value of the resources used to provide care. When, for example, costs are allocated by multiplying the patient's charges by the hospital's ratio of costs to charges, the allocated cost does not reflect actual cost because the hospital does not uniformly charge for services in proportion to their cost. The choice of method for cost allocation will be as important for the newly developed case-mix cost-accounting systems as it has been for traditional cost-accounting systems. To illustrate how the use of an indirect cost-allocation method might affect the output of a case-mix cost-accounting system, operating room, radiology and clinical laboratory costs were assigned to 106 hospitalized inguinal hernia patients in two diagnosis-related groups (DRGs) using both the hospital's existing cost-allocation method and a method that measures costs directly. Total costs and the costs in each department were significantly lower in each DRG using the direct method. It was concluded that patients in these two DRGs were being assigned more than the actual cost of their care with the existing cost-allocation method and, therefore, that the existing method prevented the case-mix accounting system from providing accurate management information.

The government and the inguinal hernia

Our review of the incidence of inguinal hernias in children based on socioeconomic differences and their risk of incarceration with its subsequent complications, was prompted by a governmental decision to disallow elective herniorrhaphy in children over 1 yr of age. The review showed the following: The risk of incarceration, the failure of preoperative reduction and the potential gonadal injury is more than three times as high in the poor child, usually covered by Medicaid. Since operative and postoperative complications increase proportional to the incidence of incarcertain, the denial of an elective herniorrhaphy endangers the life of a child. Since the increased hospitalization after incarceration also increases the financial expenditure, this rule is not only medically but also economically unsound. This review suggests that unilateral governmental health care decisions, especially those aimed at cost containment, should be carefully scrutinized to determine what price not only the society, but the patient has to pay for the "cost containment". We feel that the price of the denial of a herniorrhaphy is too high.