Abstract
Objectives
The concept of opportunity cost can be applied to the utilization of hospital beds with special focus on patients colonized or infected with multidrug-resistant organisms. Blocked beds due to isolation measures or increased length of stay may result in opportunity costs if newly arriving patients have to be rejected and the hospital is confronted with revenue foregone. However, the amount of these costs is unclear, since different approaches are used in the literature to determine the respective costs. Our paper develops a concept to assess opportunity costs from the perspective of a hospital.
Methods
The analysis is two-stage. In a first step, the probability of rejecting a patient due to over-occupancy in a hospital is calculated with a queuing model and a Monte Carlo simulation taking various assumptions into account. In a second step, the amount of the opportunity costs is calculated as an expected value applying a stochastic approach based on a potential patient pool.
Results
Opportunity costs will occur only with a probability that is influenced, among others, by current bed occupancy rates. They have to be measured by average net revenue foregone, i.e., by the difference between average revenue foregone and average costs avoided.
Conclusions
Previous studies have a tendency of overestimating the occurrence or the size of opportunity costs with regard to the use of hospital beds. Nonetheless, its influence on the hospital budget is crucial and should be determined exactly.
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References
Parker, R.H.: Macmillan dictionary of accounting. Palgrave Macmillan, Basingstoke (1984)
Conway, E.: Opportunitätskosten. In: 50 Schlüsselideen Wirtschaftswissenschaft. Spektrum Akademischer Verlag, Heidelberg (2011). https://doi.org/10.1007/978-3-8274-2635-2_5
Besanko, D.A., Braeutigam, R.R.: Microeconomics, 4th edn. Wiley, Hoboken (2010)
Frank, R.H.: Microeconomics and behavior, 9th edn. McGraw Hill, New York (2014)
Mankiw, N.G.: Principles of economics, 7th edn. Cengage Learning, Boston (2014)
Pindyck, R.S., Rubinfeld, D.L.: Microeconomics, 8th edn. Prentice Hall, Upper Saddle River (2012)
Palmer, S., Raftery, J.: Economic notes: opportunity cost. BMJ 318(7197), 1551–1552 (1999)
Tubbicke, A., Hubner, C., Hubner, N.O., Wegner, C., Kramer, A., Flessa, S.: Cost comparison of MRSA screening and management—a decision tree analysis. BMC Health Serv. Res 12, 438 (2012)
Karlsberg Schaffer, S., Sussex, J., Hughes, D., Devlin, N.: Opportunity costs and local health service spending decisions: a qualitative study from Wales. BMC Health Serv. Res. 16, 103 (2016)
Hübner, N.-O., Kramer, A.: Multiresistente gramnegative Bakterien (MRGN). In: Kramer, A., Assadian, O., Exner, M., Hübner, N.O., Simon, A. (eds.) Krankenhaus- und Praxishygiene, vol. 3, pp. 255–256. Urban & Fischer, München (2016)
de Kraker, M.E., Davey, P.G., Grundmann, H.: Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med. 8(10), e1001104 (2011)
Hübner, C., Flessa, S.: Reimbursement for hospital acquired infections with multidrug resistant organisms in German DRG system. Econ. Sociol. 9(3), 111–118 (2016)
Geldner, G., Ruoff, M., Hoffmann, H.J., Kiefer, P., Georgieff, M., Wiedeck, H.: Cost analysis concerning MRSA-infection in ICU. Anasthesiol. Intensivmed. Notfallmed. Schmerzther. 34(7), 409–413 (1999)
Herr, C.E., Heckrodt, T.H., Hofmann, F.A., Schnettler, R., Eikmann, T.F.: Additional costs for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward. Infect. Control Hosp. Epidemiol. 24(9), 673–678 (2003)
Wernitz, M.H., Keck, S., Swidsinski, S., Schulz, S., Veit, S.K.: Cost analysis of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment. Clin. Microbiol. Infect. 11(6), 466–471 (2005)
Hubner, C., Hubner, N.O., Hopert, K., Maletzki, S., Flessa, S.: Analysis of MRSA-attributed costs of hospitalized patients in Germany. Eur. J. Clin. Microbiol. Infect. Dis. 33(10), 1817–1822 (2014)
Sagel, U., Schulte, B., Heeg, P., Borgmann, S.: Vancomycin-resistant enterococci outbreak, Germany, and calculation of outbreak start. Emerg. Infect. Dis. 14(2), 317–319 (2008)
Organisation for Economic Cooperation and Development (OECD), OECD Health Statistics 2015. OECD Publishing, Paris (2015). https://doi.org/10.1787/health-data-en
Deutsches Krankenhaus institut (DKI): Krankenhaus Barometer Umfrage 2011. DKI Publishing, Duesseldorf (2011). http://www.dkgev.de/media/file/10655.Krankenhaus_Barometer_2011.pdf
Bain, C.A., Taylor, P.G., McDonnell, G., Georgiou, A.: Myths of ideal hospital occupancy. Med. J. Aust. 192(1), 42–43 (2010)
Morton, A.P.: Is quality of care improving? Hospital safety and complexity. BMJ 342, d1320 (2011)
Meyer, M., Hansen, K.: Planungsverfahren des Operations Research. Vahlen, München (1985)
Fehrle, M., Michl, S., Alte, D., Götz, O., Fleßa, S.: Zeitmessstudien im Krankenhaus. Gesundheitsökonomie Qualitätsmanagement 18(1), 23–30 (2013)
Roberts, R.R., Frutos, P.W., Ciavarella, G.G., Gussow, L.M., Mensah, E.K., Kampe, L.M., Straus, H.E., Joseph, G., Rydman, R.J.: Distribution of variable vs fixed costs of hospital care. JAMA 281(7), 644–649 (1999)
Haubrock, M.: Krankenhausfinanzwirtschaft. In: Haubrock, M., Schär, W. (eds.) Betriebswirtschaft und Management im Krankenhaus, pp. 394–453. Huber, Bern (2007)
Graves, N.: Economics and preventing hospital-acquired infection. Emerg. Infect. Dis. 10(4), 561–566 (2004)
Page, K., Barnett, A.G., Graves, N.: What is a hospital bed day worth? A contingent valuation study of hospital chief executive officers. BMC Health Serv. Res. 17(1), 137 (2017)
Tubbicke, A., Hubner, C., Kramer, A., Hubner, N.O., Flessa, S.: Transmission rates, screening methods and costs of MRSA–a systematic literature review related to the prevalence in Germany. Eur. J. Clin. Microbiol. Infect. Dis. 31(10), 2497–2511 (2012)
Huebner, C., Roggelin, M., Flessa, S.: Economic burden of multidrug-resistant bacteria in nursing homes in Germany: a cost analysis based on empirical data. BMJ Open 6(2), e008458 (2016)
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Hübner, C., Ried, W. & Flessa, S. Assessing the opportunity costs of patients with multidrug-resistant organisms in hospitals. Eur J Health Econ 19, 1009–1017 (2018). https://doi.org/10.1007/s10198-017-0949-8
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DOI: https://doi.org/10.1007/s10198-017-0949-8
Keywords
- Opportunity costs
- Hospital
- Net revenue foregone
- Monte Carlo simulation
- Decision-making
- Multidrug-resistant organisms