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Skopec L, Berenson RA, Simon B, Papanicolas I. Variation in processes of care for total hip arthroplasty across high-income countries. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae043. [PMID: 38756170 PMCID: PMC11060656 DOI: 10.1093/haschl/qxae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Total hip arthroplasty (THA) is among the most commonly performed elective surgeries in high-income countries, and wait times for THA have frequently been cited by US commentators as evidence that countries with universal insurance programs or national health systems "ration" care. This novel qualitative study explores processes of care for hip replacement in the United States and 6 high-income countries with a focus on eligibility, wait times, decision-making, postoperative care, and payment policies. We found no evidence of rationing or government interference in decision-making across high-income countries. Compared with the 6 other high-income countries in our study, the United States has developed efficient care processes that often allow for a same-day discharge. In contrast, THA patients in Germany stay in the hospital 7-9 days and receive 2-3 weeks of inpatient rehabilitation. However, the payment per THA in the United States remains far above other countries, despite far fewer inpatient days.
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Affiliation(s)
- Laura Skopec
- Health Policy Center, Urban Institute, Washington, DC 20037, United States
| | - Robert A Berenson
- Health Policy Center, Urban Institute, Washington, DC 20037, United States
| | - Benedikt Simon
- Department for Integrated and Digital Care, Asklepios Kliniken GmbH & Co KGaA, 22307 Hamburg, Germany
| | - Irene Papanicolas
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI 02903, United States
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Gutwerk A, Müller M, Crönlein M, Kirchhoff C, Biberthaler P, Pförringer D, Braun K. [Analysis of rising treatment cost of elevated BMI in patients with proximal femoral fracture]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:449-455. [PMID: 35925229 DOI: 10.1007/s00113-022-01187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/01/2023]
Abstract
Driven by the aging population, the proximal femoral fracture is a rising fracture entity, challenging trauma surgeons as well as the German healthcare system as a whole. The rising average age of the population is accompanied by a rising BMI in the German population, resulting in longer operation times, longer average length of stay (ALOS) as well as more postoperative complications.The aim of this study was to demonstrate the economic correlation between body mass index and hospital costs. The retrospective analysis of 950 patient cases suffering from a proximal femoral fracture resulted in the finding of rising treatment costs being positively associated with rising BMI due to longer operation times and longer length of hospitalization (10,452 €, 11,505 €, 12,085 € and 13,681 € for patients with BMI < 18.5 kg/m2, BMI = 18.5-24.9 kg/m2, BMI = 25.0-29.9 kg/m2 and BMI ≥ 30.0 kg/m2, respectively).
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Affiliation(s)
- Alexander Gutwerk
- Klinik für Orthopädie, Unfall‑, Hand- und Plastische Chirurgie, DIAKO Krankenhaus, Knuthstr. 1, 24939, Flensburg, Deutschland.
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - Michael Müller
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Moritz Crönlein
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Chlodwig Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Dominik Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Karl Braun
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Economics of Total Hip Arthroplasty: Review. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2022. [DOI: 10.17816/2311-2905-1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This review article focuses on issues of economic analysis in providing care to patients requiring total hip arthroplasty. A large number of factors affecting the final financial result force us to look at economic research in the field of arthroplasty with a certain degree of criticality. At the same time, the existing financing systems cannot fully take into account all the possible costs arising from total hip arthroplasty. For this reason, studies concerning revision total hip arthroplasty are of particular interest, where treatment costs can vary significantly depending on the etiology and complexity of the case. These differences are reflected in the works of authors from France, Germany and Great Britain, who compared the treatment costs of patients with septic and aseptic revisions. Very different data both between countries and within the same country well demonstrate the need for a critical approach to the results of cost-effectiveness studies, QALYs based on Markov and other models, as the quality of the original data can be highly variable and reproduce the error of the initially incorrect price structure. At the same time, the rapidly increasing number of operations of primary and revision hip arthroplasty and, accordingly, the increasing economic costs of these operations require clear and effective economic criteria for their evaluation. The formation and application of these criteria will be the purpose of further research.
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Enodien B, Taha-Mehlitz S, Bachmann M, Staartjes VE, Gripp M, Staudner T, Taha A, Frey D. Analysis of Factors Relevant to Revenue Enhancement in Hernia Interventions (SwissDRG G09). Healthcare (Basel) 2021; 9:healthcare9070862. [PMID: 34356240 PMCID: PMC8306973 DOI: 10.3390/healthcare9070862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Since diagnosis-related groups (SwissDRG) were established in Switzerland in 2012, small and medium-size hospitals have encountered increasing financial troubles. Even though hernia repair operations are frequent, most hospitals fail to cover their costs with these procedures. Previous studies have focused mainly on analyzing costs and the contributing factors but less on variables that can be positively influenced. Therefore, this study aims to identify the relevant and influenceable factors for revenue growth in hernia repair surgery. Methods: Data from all patients who underwent the SwissDRG G09 surgery for a hernia in 2019 were analyzed. The contribution margin (CM4), as well as any over- or under-coverage, was correlated to case-specific costs. Results: A total of 168 patients received hernia repair surgery with the SwissDRG code G09. The average revenue/loss generated by one procedure was CHF −623.84. Procedures covered by the General Health Insurance (OKP) generated a loss of CHF −830.70 on average, whereas procedures covered by private insurance companies (VVG) generated revenue of CHF +1100 on average. Significant factors impacting the profitability of hernia repair operations were teaching during surgery (p < 0.005), the surgical operating time (p < 0.001), the total anesthesia time (p < 0.001), the number of surgeons present (p = 0.022), the insurance state of patients (p < 0.001), and the type of surgery (p < 0.01 for Lichtenstein’s procedure). Conclusions: This study reveals that hernia repair surgery performed under cost coverage by OKP is generally unprofitable. Our results further imply that the most important and influenceable factors for revenue enhancement are the quality and process optimization of the surgical department. To compensate for this deficit, hospitals should aim to increase the percentage of patients with private health insurance coverage in their procedures. Since outpatient surgery does not provide a valid alternative due to the low reimbursement by insurance companies, the cost efficiency of inpatient hernia repair needs to be increased by process optimization of the surgical department; for instance, by providing specialized hernia teams performing with shorter operation times and high quality.
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Affiliation(s)
- Bassey Enodien
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | - Stephanie Taha-Mehlitz
- Clarunis University Center for Gastrointestinal and Liver Diseases, 4002 Basel, Switzerland;
| | - Marta Bachmann
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | | | - Maike Gripp
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | - Tobias Staudner
- Department of Visceral and Thoracic Surgery Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Anas Taha
- Department of Visceral and Thoracic Surgery Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
- Correspondence: ; Tel.: +41-52-266-4021
| | - Daniel Frey
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
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Günsche JL, Pilz V, Hanstein T, Skripitz R. The variation of arthroplasty procedures in the OECD Countries: analysis of possible influencing factors by linear regression. Orthop Rev (Pavia) 2020; 12:8526. [PMID: 33312485 PMCID: PMC7726828 DOI: 10.4081/or.2020.8526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023] Open
Abstract
Total hip and knee replacements (THR, TKR) are among the most common surgeries but incidence rates vary between OECD countries. Previous studies suggested economic factors to be most influential but did not take into account health care system related factors. Hence we analysed the possible influence of healthcare system related factors on the operation rate. We used OECD data for 27 countries and calculated Age-Standardized Incidence Rates (ASIR). In order to determine possible explanatory variables on the ASIRs we performed a stepwise blockwise linear regression. The ASIR of hip and knee replacement varies widely. We identified statistically significant determinants which influence the ASIR of THR in a positive manner: incidence and length of stay of coxarthrosis, ASIR of knee replacement, health expenditures, number of nurses and an etatistic social insurance. Diabetes prevalence, gross domestic product and number of doctor consultations, however, have a negative influence on the ASIR. TKR rate is positively influenced by health expenditures and incidence rate of gonarthrosis, negatively by the number of primary practitioners. We observed strong geographic disparities in the frequency of THR and THR that cannot be explained by age structure of the countries. Economic factors seem to play a secondary role while healthcare related factors have a greater influence.
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Affiliation(s)
- Jamie Lee Günsche
- Bavarian State Office for Statistics, Schweinfurt Office, Schweinfurt.,Heraeus Medical GmbH, Health Economics, Wehrheim
| | | | - Tim Hanstein
- Heraeus Medical GmbH, Health Economics, Wehrheim.,Rostock University Medical Center, Orthopedic Clinic and Policlinic; Rostock
| | - Ralf Skripitz
- Rostock University Medical Center, Orthopedic Clinic and Policlinic; Rostock.,Roland- Klinik, Centre forArthroplasty, Foot Surgery, Paediatric and General Orthopaedics, Bremen, Germany
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