The Case of MRI Repetitions with Direct and Indirect Cost Implications: Evidence from Hacettepe University Hospitals

Year 2019, Volume: 27 Issue: 41, 253 - 262, 31.07.2019

Dilek Başar İlhan Can Özen Selcen Öztürk Ekim Gümeler Deniz Akata Arbay Özden Çiftçi

https://doi.org/10.17233/sosyoekonomi.2019.03.13

Cited By: 1

Abstract

This study investigates the case of repeated MRIs using data from Hacettepe University Hospitals. Results indicate that almost 34% of MRI consultations have to be repeated within the same year due to suboptimal quality that hinders correct assessment and diagnosis. Suboptimal quality refers to; movement artefacts, use of wrong scan technique or sequence, inexperienced reader and/or shortened time intervals. In fact, almost 30% of those repetitions result in a change in diagnosis. Results suggest that the probability of repetition is higher among women and children.

Keywords

Health Policy, MRI Overutilization, Direct and Indirect Costs, Turkey

Tekrarlanan MR Görüntülemelerinin Doğrudan ve Dolaylı Maliyet Etkileri: Hacettepe Üniversitesi Hastanelerinden Bulgular

Abstract

Bu çalışma Hacettepe Üniversitesi Hastanelerinden elde edilen veriler aracılığıyla tekrarlanan MR incelemelerini araştırmaktadır. Çalışmadan elde edilen sonuçlar konsülte edilen MR’ların yaklaşık %34’ünün düşük kalite sebebiyle aynı yıl içinde tekrar edildiğini göstermiştir. Düşük kalite; hareket artefaktları, yanlış tarama tekniği veya dizisinin kullanımı, deneyimsiz okuyucu ve / veya kısaltılmış zaman aralıkları olarak tanımlanmaktadır. Söz konusu MR’ların %30’unda ise tanı değişikliği olmuştur. Sonuçlar çocuklar ve kadınlar için tekrar olasılığının daha yüksek olduğuna işaret etmektedir.

Keywords

Sağlık Politikası, Aşırı MR Kullanımı, Doğrudan ve Dolaylı Maliyetler, Türkiye

References

• Arıkan, A. & S. Çınarlı & F.Ş. Aykar & A. Sayan (2017), “Attitudes of Medical Malpractice in Pediatric Surgery”, The Journal of Pediatric Research, 4(3), 117.
• Armao, D. & R.C. Semelka & J. Elias Jr (2012), “Radiology's ethical responsibility for healthcare reform: tempering the overutilization of medical screening and trimming down a heavyweight”, Journal of magnetic resonance screening, 35(3), 512-517.
• Başar, D. & S. Öztürk & İ. Cakmak (2018), “An Application of the Behavioral Model to the Utilization of Health Care Services in Turkey: A Focus on Equity”, Panoeconomicus, Advance online publication, 1-22.
• Bilimoria, K.Y. & J.W. Chung & C.A. Minami & M.W. Sohn & E.S. Pavey & J.L. Holl & M.M. Mello (2017), “Relationship between state malpractice environment and quality of health care in the United States”, The Joint Commission Journal on Quality and Patient Safety, 43(5), 241-250.
• Cascade, P.N. & E.W. Webster & E.A. Kazerooni (1998), “Ineffective use of radiology: the hidden cost”, AJR. American journal of roentgenology, 170(3), 561-564.
• Colla, C.H. & A.J. Mainor & C. Hargreaves & T. Sequist & N. Morden (2017), “Interventions aimed at reducing use of low-value health services: a systematic review”, Medical Care Research and Review, 74(5), 507-550.
• Dinan, M.A. & L.H. Curtis & B.G. Hammill & E.F. Patz & A.P. Abernethy & A.M. Shea & K.A. Schulman (2010), “Changes in the use and costs of diagnostic screening among Medicare beneficiaries with cancer, 1999-2006”, Jama, 303(16), 1625-1631.
• Eş, H. & Y. Özer & Z. Liman & A. Şanlı (2017), “General surgery malpractice claims in Turkey”, Romanian Journal of Legal Medicine, (2), 272-278.
• Hendee, W.R. & G.J. Becker & J.P. Borgstede & J. Bosma & W.J. Casarella & B.A. Erickson & P.E. Wallner (2010), “Addressing overutilization in medical screening”, Radiology, 257(1), 240-245.
• Hillman, B.J. & C.A. Joseph & M.R. Mabry & J.H. Sunshine & S.D. Kennedy & M. Noether (1990), “Frequency and costs of diagnostic screening in office practice-a comparison of self-referring and radiologist-referring physicians”, New England Journal of Medicine, 323(23), 1604-1608.
• Hosmer, D.W. & S. Lemeshow (2000), Applied Logistic Regression, John Wiley & Sons.
• Küçük, M. (2018), “Defensive medicine among obstetricians and gynaecologists in Turkey”, Journal of Obstetrics and Gynaecology, 38(2), 200-205.
• Lang, K. & H. Huang & D.W. Lee & V. Federico & J. Menzin (2013), “National trends in advanced outpatient diagnostic screening utilization: an analysis of the medical expenditure panel survey, 2000-2009”, BMC Medical Screening, 13(1), 40.
• Mafi, J.N. & K. Russell & B.A. Bortz & M. Dachary & W.A. Hazel Jr & A.M. Fendrick (2017), “Low-cost, high-volume health services contribute the most to unnecessary health spending”, Health Affairs, 36(10), 1701-1704.
• Mello, M.M. & D.M. Studdert & T.A. Brennan (2003), “The new medical malpractice crisis”, New England Journal of Medicine, 348(23), 2281-2284.
• Ozmen, P. & S. Sahin & M. Cetin & Y.Z. Turk (2015), “A Medical Malpractice Research Conducted in Turkey, Causes and the Role of Media”, Journal of Archives in Military Medicine, 3(2).
• Sistrom, C. & N.L. McKay & J.B. Weilburg & S.J. Atlas & T.G. Ferris (2012), “Determinants of diagnostic screening utilization in primary care”, The American journal of managed care, 18(4), e135-44.
• Smith-Bindman, R. & D.L. Miglioretti & E.B. Larson (2008), “Rising use of diagnostic medical screening in a large integrated health system”, Health Affairs, 27(6), 1491-1502.
• Solaroglu, I. & Y. Izci & H.G. Yeter & M.M. Metin & G.E. Keles (2014), “Health transformation project and defensive medicine practice among neurosurgeons in Turkey”, PloS one, 9(10), e111446.
• TCSB SAGM (2017), Sağlık İstatistikleri Yıllığı 2016, Ankara.
• Tynan, A. & R.A. Berenson & J.B. Christianson (2008), “Health plans target advanced screening services: cost, quality and safety concerns prompt renewed oversight”, Issue Brief (Center for Studying Health System Change), (118), 1-4.