Analysis of high cost outliers in a polish reference hospital

Abstract

The growing fi nancial problems of healthcare institutions contribute to the search of methods in properly distributing and clearly justifying resources. One of these is detecting outliers accounting for an important share of hospital costs. The aim of the study is to identify the factors facilitating identifi cation of cost outliers in one of the Polish reference hospitals in northeast Poland. We have analyzed 4,570 patients. Cost analysis was done retrospectively using accountancy and statistical data from the hospital. To select the outliers, we used the interquartile method using the median and the interquartile distance. To evaluate the factors that infl uence the patient being a cost outlier, we considered: age, length of stay, gender, type of admission, reason of discharge, and type of department. Univariate analysis and multivariable logistic regression were used in the study. Our study revealed that the small percentage of the patients is responsible for the signifi cant level of costs. The total cost outliers comprised 9% of the study sample. They accounted for almost 37% of total hospital costs, 40% of direct costs, and 34% of indirect costs. We discovered that age, gender, length of stay, reason of discharge, and type of department has a signifi cant infl uence on being the cost outlier. The study revealed that the probability of being the CO increased more than 6 times for the surgical patients. This is consistent with the analysis of CO by ICD 10. The analysis revealed that almost all patients suffered from diseases related to high proportion of CO, required surgery treatment. It is concluded that identifying the cost outliers can contribute to better knowledge by managers about the nature of the costs outliers and can be especially valuable in the fi nancing systems where high costs outliers are separately paid.