A study based on national DRG data to evaluate work load and practice relating to cancer patients in not-for-profit hospitals

Background: In France there is no reliable information describing the organ isation of hospital care for patients with cancer. The present study attemp ts to clarify this issue taking advantage of an information source that has up to now been unused, namely the national PMSI (Information System Medica l program) data base. Methods: A quantitative study has been carried out regarding cancer managem ent in France using information filed with the PMSI which compiles data rel ated to hospital admissions in all institutions with more than 100 beds and subject to a defined global budget. The "cancer" component of hospital act ivity was extracted using a specific algorithm which utilized the diagnosti c and intervention codes included in the admission summaries. By using the unit of activity as defined by the ISA (Activity Synthetic Index) and the s cale of relative cost according to the GHM (Homogeneous Group of patients) it was possible to analyse the information in terms of a balance sheet. Results: The study provided information regarding the costs and methods of management, including therapeutic strategies, for each type of hospital est ablishment. It is shown that with one death out of six, cancer covers a qua rter of all hospital stays, and one sixth of annual hospital expenses, This accounts for 16.2 % of ISA ie approximately 29 billion francs (4.6 billion dollars) for the public and semipublic sectors. Surgery, which accounted f or 32 % of expenditures, appeared to be the most expensive intervention, ah ead of chemotherapy (16.3 %) and radiotherapy (9.1 %). Each type of hospita l organisation (university, cancer centre, district hospital) had their own relative figures. Conclusion: Through this study the current situation regarding cancer care in hospital has been documented. It has also demonstrated the value of the PMSI data base as a source of information for large scale quantitative stud ies of health care economics. However, the PMSI does nor yet provide detail s regarding infrastructure or succession of hospital stay. Ultimately, this analysis does not provide any information on the quality or efficacy of ca re but does define a typological system for health care organisations which could provide information on distribution of resources.