Health Care as a "Market Good"? Appendicitis as a Case Study

University of California, San Francisco, and Ecologic Institute, Berlin, Germany (Dr Srebotnjak).
Archives of internal medicine (Impact Factor: 17.33). 04/2012; 172(10):818-9. DOI: 10.1001/archinternmed.2012.1173
Source: PubMed
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    • "Charges for specific episodes of care, on the other hand, while not exactly the same should have less patient level variation and therefore more validity when evaluating between-hospital differences in charges and prices. [7] Further, the variation in charge for common episodes of care is of more use from a consumer perspective when deciding which hospital to visit for a specific complaint or procedure. "
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    ABSTRACT: BackgroundThough past studies have shown wide variation in aggregate hospital price indices and specific procedures, few have documented or explained such variation for distinct and common episodes of care.ObjectivesWe sought to examine the variability in charges for percutaneous coronary intervention (PCI) with a drug-eluting stent and without major complications (MS-DRG-247), and determine whether hospital and market characteristics influenced these charges.MethodsWe conducted a cross-sectional analysis of adults admitted to California hospitals in 2011 for MS-DRG-247 using patient discharge data from the California Office of Statewide Health Planning and Development. We used a two-part linear regression model to first estimate hospital-specific charges adjusted for patient characteristics, and then examine whether the between-hospital variation in those estimated charges was explained by hospital and market characteristics.ResultsAdjusted charges for the average California patient admitted for uncomplicated PCI ranged from $22,047 to $165,386 (median: $88,350) depending on which hospital the patient visited. Hospitals in areas with the highest cost of living, those in rural areas, and those with more Medicare patients had higher charges, while government-owned hospitals charged less. Overall, our model explained 43% of the variation in adjusted charges. Estimated discounted prices paid by private insurers ranged from $3,421 to $80,903 (median: $28,571).ConclusionsCharges and estimated discounted prices vary widely between hospitals for the average California patient undergoing PCI without major complications, a common and relatively homogeneous episode of care. Though observable hospital characteristics account for some of this variation, the majority remains unexplained.
    Full-text · Article · Aug 2014 · PLoS ONE
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    • "In the United States the annual rate of appendicitis has increased from 7.62 per 10,000 in 1998 to 9.38 per 10,000 in 2008 [2]. Further the cost of diagnosis and treatment of acute appendicitis has been shown to range from $1529 to $182,955 with a median of $33,611 [3]. Sir Zachary Cope stated, 'Diagnosis of appendicitis is usually easy' [4], and for decades we have based the diagnosis on the patient's medical history and physical examination , with laboratory investigations only aiding with interpretation of clinical findings [5]. "
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    ABSTRACT: In the past decade there has been an exponential increase in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. The aim of this study was to compare management approaches and clinical outcomes of acute appendicitis in Sri Lanka and the United Kingdom. Data was collected prospectively from 400 patients referred to the General Surgical department with a differential diagnosis of acute appendicitis, 200 at University Kelaniya Sri Lanka (SL group), and 200 at University College London Hospital (UK group). The groups were similar with respect to gender, but the SL group was younger. Preoperative work-up included ultrasound more commonly in SL patients, and CT more commonly in UK patients. More patients underwent appendicectomy in the SL group, however a laparoscopic approach was utilized more often in the UK group (50.5% vs. 11.9%). Post-operative complications were similarly represented in both groups, but re-admission occurred with greater frequency in the UK group (16.2% vs. 0%). Histologically confirmed appendicitis was seen in a significantly greater proportion of SL patients (93.1% vs. 79.8%). Multivariate analysis confirmed male gender, and diagnosis and treatment in Sri Lanka to be only factors significantly associated with positive appendicitis. Expensive investigations such as CT do not appear to improve the diagnostic accuracy of appendicitis or prevent complications. This study suggests diagnostic and treatment algorithms in the SL hospital are more accurate and efficient in confirming appendicitis than those seen in the UK hospital under investigation.
    Full-text · Article · Jan 2014 · International Journal of Surgery (London, England)

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