Day clinics and hospitals - a cost comparison
Objective. To determine the types of surgical procedures currently undertaken in day clinics and to compare the number of procedures, the average in-facility cost, and the pre- and post-discharge costs for each procedure or group of procedures.
Design. A retrospective descriptive study of medical aid claims data.
Setting. Department of Family Medicine, University of the Witwatersrand, Johannesburg.
Subject. Three private sector medical aid schemes with in excess of 170 000 principal members (380 000 lives).
Outcome measures. For each surgical procedure. the following were compared: (i) the total number of procedures done; (ii) the average total in-facility cost; and (iii) the cost of professional fees and medicines for 7 days before admission, during admission, and for 14 days after discharge.
Results. During 1997, 89 216 patients underwent surgery. Day clinics and hospitals accounted for 5 490 and 83 726 admissions respectively. Fifty-one different types of procedures were identified that met the inclusion criteria.
On average the in-facility costs for 45 (88%) of the 51 compared procedures were lower in day clinics compared with hospitals. Average costs can be as much as 90% lower in day clinics. Some procedures, particularly certain dental operations, cost more in day clinics. The professional fees of attending doctors and the cost of medicines are generally higher when the procedure is undertaken in a hospital.
Conclusion. In South Africa, as is the case in the USA, day clinics have the potential to reduce the cost of surgical procedures.
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