Costs of anesthesia.

Abstract

he practice of anesthesia faces many of the conflicting demands for better technology, lower T costs, improved outcome, and tighter control found in our current health care environment. The providers of anesthesia must make decisions amid demands from surgical patients, hospitals, purveyors of technology, and nonpatient payers. These anesthesia providers, in addition to being expensive themselves, order preoperative tests, control operating and recovery room usage, and consume large amounts of hospital supplies and services. Expenditures controlled by anesthesia providers represent 3-5% of the total health care costs of the United States. (Anesthesia provider charges approximate $9 billion per year. Roizen estimates $11.7 billion for preoperative tests [personal communication]. Anesthesia supply and facility charges are unknown. Total health care costs are approximately $800 billion [ll.) The market for surgery and anesthesia does not follow conventional supply/ demand and cost/quality equilibrium laws (2). This is known as market failure, a situation that calls for special strategies for controlling costs and assessing tradeoffs. Investigating and understanding these strategies in the anesthesia market may produce strategies for other health care markets, such as intensive care medicine, which operate under similar conditions of market failure and consume large amounts of health care dollars (3). Anesthesiology is a facility-based service integral to quality health care, without which most surgery and much intensive care would not be possible (4). Approximately 26 million surgical procedures are performed in the United States each year. The contribution to, and control of, large dollar expenditures in this market by anesthesia providers, as well as insurance companies and other payer groups, requires their inclusion in studies of delivering and paying for quality health care. Analyzing the costs and cost determinants, as well as the risks, benefits, and effectiveness of