A sample of motor vehicle accident victims hospitalized at Vancouver General Hospital, Vancouver, British Columbia, was chosen to analyze the relationship between hospital costs and the severity of the patient's injury or illness. Severity was measured using two scales, specifically, the Injury Severity Scale and the Abbreviated Injury Scale. Hospital costs were also measured, using two different methodologies. The first was the Per Diem costs that were derived by dividing all related annual costs by the number of patient separation days in 1975. A Per Diem episodic cost was determined by multiplying length of stay by the daily average cost. The second approach used a step-down technique that distributed all non-patient care related hospital services across direct patient care departments, cost centres or programs. Unit costs were then developed for each cost centre, depending upon their annual workload. The 1975 medical record for each patient in the sample was analyzed to determine the number of work units used in each cost centre during the patient's hospital stay. A Step-Down episodic cost was determined by totalling all costs from each cost centre that provided services to the patient. A paired t-Test did not show a significant difference between the Per Diem and Step-Down episodic costs. It was assumed that the range of severity of the patient in the sample weakened this t-Test, severity measured by I.S.S. was grouped in low, medium, and high categories, or when severity was measured by A.I.S., the paired t-Test did show that there was a significant difference in the two costing methodologies. The regression analysis identified a significant relationship between both episodic costs and severity. The strongest relationship occurred when severity was measured by I.S.S. and costs were determined, using the Step-Down methodology (R² = 0.26, F = 35.45). When other related independent variables (i.e., death as outcome and operation not performed) and all interaction terms were introduced, the regression co-efficient increased to R² = 0.45 and the F value increased to F = 24.9. Recommendations were made to include a severity rating on all hospitalized patients' records to assist in patient classification. A final outcome of this study was identifying the value of a Step-Down approach to determining hospital costs and identifying the limitations of the Per Diem methodology of hospital accounting. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

No description available.

Considerable attention has been devoted in the past to documenting the impact of prepaid group practices and community health centres on inpatient hospital utilization. The thesis develops and applies a methodology designed to allow estimation of the fiscal implications of such evidence. An equation relating average hospital inpatient costs to a number of explanatory variables is specified. The maximum likelihood estimation technique is employed in a time-series/cross-section analysis to determine parameter estimates for that equation over the period 1966-73. The variables are constructed from data deriving from eighty-seven British Columbia public general hospitals. Empirical results indicate the importance of case mix, average length of inpatient stay, rate of case flow and education-related hospital activities in explaining the variance across the eighty-seven hospitals in average cost per separation. The parameter estimates derived in the unit cost analysis are utilized in a comparative static determination of the implications for unit costs of changes in a hospital's case mix. The impact of case-specific case mix changes on unit (per separation) costs is determined, from which analysis case-specific marginal costs are derived. Finally, the marginal case costs are combined with utilization statistics from matched population studies involving community health centres or prepaid group practices. This allows determination of the expenditure implications of the utilization differentials reported in that literature. A subsequent extrapolative and conjectural analysis considers the cost implications of more widespread use of community health centres as a mode of medical care delivery in British Columbia. The conclusions suggest that the fiscal impact on the overall medical care budget in B.C. would be minimal in the absence of corresponding reductions in numbers of hospital beds. A number of other applications of the case cost derivation methodology are suggested. / Arts, Faculty of / Vancouver School of Economics / Graduate

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

University of Macau / Institute of Chinese Medical Sciences

University of Macau / Institute of Chinese Medical Sciences