PROSPECTIVE PAYMENT SYSTEMS AND HIP FRACTURE TREATMENT COSTS

We studied the health care consumption and costs after a hip fracture in 1,060 and 1,178 elderly patients admitted from their own home befor e and after the implementation of a prospective payment system in Stoc kholm. The total number of bed-days was estimated by merging the inpat ient database and the municipal records of living accommodations for t he elderly By using a detailed patient-related accounting system and s eparating cost for surgery and ''hotel'' cost, we could compare costs in different types of rehabilitation. After the change in reimbursemen t system, the orthopedic stay was almost halved from 20 to 12 days. Th is was achieved by earlier and increased discharge to geriatric wards, where bed-day consumption doubled (107%), so that the total cost actu ally increased by 12%. This is not readily apparent from the official health care statistics, which depict a more favorable cost development , as diagnosis-related registration for a large part of the geriatric care is no longer included. In contrast, a rehabilitation program in o ne of the acute hospitals, emphasizing continuity in the postoperative phase, reduced the total cost for treatment and rehabilitation by 12% . A prospective reimbursement aiming at reducing the costs of acute ca re does not necessarily result in overall savings.