Abstract
BackgroundAs health care costs continue to increase worldwide, health care systems, and more specifically hospitals are facing continuous pressure to operate more efficiently. One service within the hospital sector whose cost structure has been modestly investigated is the Emergency Department (ED). The study aims to report on the distribution of ED resource use, as expressed in charges, and to determine predictors of/contributors to total ED charges at a major tertiary hospital in Lebanon.MethodsThe study used data extracted from the ED discharge database for visits between July 31, 2012 and July 31, 2014. Patient visit bills were reported under six major categories: solutions, pharmacy, laboratory, physicians, facility, and radiology. Characteristics of ED visits were summarized according to patient gender, age, acuity score, and disposition. Univariate and multivariate analyses were conducted with total charges as the dependent variable.ResultsFindings revealed that the professional fee (40.9 %) followed by facility fee (26.1 %) accounted for the majority of the ED charges. While greater than 80 % of visit charges went to physician and facility fee for low acuity cases, these contributed to only 52 and 54 % of the high acuity presentations where ancillary services and solutions’ contribution to the total charges increased. The total charges for males were $14 higher than females; age was a predictor of higher charges with total charges of patients greater than 60 years of age being around $113 higher than ages 0–18 after controlling for all other variables.ConclusionUnderstanding the components and determinants of ED charges is essential to developing cost-containment interventions. Institutional modeling of charging patterns can be used to offer price estimates to ED patients who request this information and ultimately help create market competition to drive down costs.
Highlights
As health care costs continue to increase worldwide, health care systems, and hospitals are facing continuous pressure to operate more efficiently
Physician charges represented the highest proportion of total charges (40.9 %), followed by facility that constituted 26.1 % of total charges, laboratory (13.8 %) radiology (12.5 %), solutions (4.8 %) and pharmacy (1.9 %) (Fig. 1)
This study revealed two interesting findings: 1) higher acuity patients had a greater proportion of the Emergency Department (ED) charges attributed to ancillary services including radiology and laboratory and 2) the lower ESI the higher the total charges even after controlling for other variables, with ESI 1 charges being $307 higher than ESI 5
Summary
As health care costs continue to increase worldwide, health care systems, and hospitals are facing continuous pressure to operate more efficiently. One service within the hospital sector whose cost structure has been modestly investigated is the Emergency Department (ED). This is despite the common belief, supported by. With the global trend of increasing ED utilization and associated costs, various cost containment solutions are being proposed in the literature including price transparency and financial counseling in the ED [1, 16, 19] Such initiatives make understanding the structure of ED costs of paramount importance. Few studies have investigated such an important topic, especially examining the resource use distribution in ED visits and potential contributors to it [2, 3, 19,20,21]
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