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Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanımı ve gider analizi

Year 2021, , 315 - 323, 29.09.2021
https://doi.org/10.18663/tjcl.824967

Abstract

Amaç: Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanım durumunu çeşitli göstergelerle analiz etmek ve hastane maliyetleri üzerindeki etkisine dikkat çekmektir.
Gereç ve Yöntemler: Kamu hastanelerinde 2015-2019 yıllarına ait laboratuvar testlerinin kullanımı, test istem oranları, laboratuvar giderleri ve tıbbi hizmet verileri Sağlık Bakanlığı’ndan temin edilmiştir. Sağlık Bakanlığı’nın çeşitli veri tabanlarından elde edilen veriler, sentezlenerek analiz edilmiştir.
Bulgular: 2019 yılında 2,7 milyar liraya yükselen laboratuvar giderlerinin, kamu hastanelerinin toplam gideri içindeki oranı %5,67 düzeyindedir. Volüm ve gelir olarak ilk 25 teste bakıldığında; testlerin genellikle benzer olduğu, farklılıkların ise geri ödeme fiyatlarının yüksekliğinden kaynaklandığı görülmektedir. Dal eğitim ve araştırma hastanelerinde test istem oranı ile test başı giderin fazla olduğu bulunmuştur. Yaşlı nüfusun ve ortanca yaşın yüksek olduğu illerde aynı zamanda test istem oranının da fazla olması, kronik hastalık takibinin test istemini artıran bir etken olduğu kanıtı niteliğindedir. Gereksiz test istemleri (D vitamini gibi), hastane giderleri üzerinde önemli bir mali yük oluşturmaktadır.
Sonuç: Türkiye’de laboratuvar giderlerinin sürekli artış göstermesinin nedenlerinden biri olan fazla veya gereksiz test isteminin önüne geçilebilmesi için, akılcı laboratuvar kullanımı projeleri etkin bir şekilde yürütülmelidir. Laboratuvar testlerinin uygunluğunu geliştirmek, sadece maliyet etkinliği sağlamakla kalmaz, aynı zamanda daha fazla klinik fayda ve hasta güvenliğine katkı sağlar.

References

  • 1. TÜİK, Sağlık Harcamaları İstatistikleri-2018. TÜİK Haber Bülteni, 12 Kasım 2019, Sayı: 30624.
  • 2. Konger RL, Ndekwe P, Jones G et al. Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital. Am J Clin Pathol 2016; 145: 355-64.
  • 3. Alonso-Cerezo MC, Martín JS, García Montes MA, de la Iglesia VM. Appropriate utilization of clinical laboratory tests. Clin Chem Lab Med 2009; 47: 1461-5.
  • 4. O'Sullivan JW, Stevens S, Hobbs FDR et al. Temporal trends in use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests. BMJ 2018; 363: 4666.
  • 5. Khalifa M, Khalid P. Reducing Unnecessary Laboratory Testing Using Health Informatics Applications: A Case Study on a Tertiary Care Hospital. Procedia Computer Science 2014; 37: 253-60.
  • 6. Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis. PLOS ONE 2013; 8: 78962.
  • 7. Bindraban RS, Ten Berg MJ, Naaktgeboren CA, Kramer MHH, Van Solinge WW, Nanayakkara PWB. Reducing Test Utilization in Hospital Settings: A Narrative Review. Ann Lab Med. 2018; 38: 402-12.
  • 8. Mrazek C, Simundic, AM, Salinas, M et al. Inappropriate use of laboratory tests: How availability triggers demand-Examples across Europe, Clinica Chimica Acta 2020; 505: 100-7.
  • 9. van Walraven C, Raymond M. Population-based study of repeat laboratory testing. Clin Chem 2003; 49: 1997-2005.
  • 10. Morgen EK, Naugler C. Inappropriate repeats of six common tests in a Canadian city: a population cohort study within a laboratory informatics framework. Am J Clin Pathol 2015; 144: 704-12.
  • 11. Baron JM, Dighe AS. The role of informatics and decision support in utilization management. Clin Chim Acta 2014; 427: 196-201.
  • 12. Fryer AA, Smellie WS. Managing demand for laboratory tests: a laboratory toolkit. J Clin Pathol 2013; 66: 62-72.
  • 13. Janssens PM, Wasser G. Managing laboratory test ordering through test frequency filtering. Clin Chem Lab Med 2013; 51: 1207-15.
  • 14. Ducatman BS, Ducatman AM, Crawford JM, Laposata M, Sanfilippo F. The Value Proposition for Pathologists: A Population Health Approach. Acad Pathol 2020; 7: 1-12.
  • 15. Larsson A, Palmer M, Hultén G, Tryding N. Large Differences in Laboratory Utilisation between Hospitals in Sweden, Clinical Chemistry and Laboratory Medicine, 2000; 38: 383-9.
  • 16. Sağlık Bakanlığı, Sağlık İstatistik Yıllığı-2019, Sağlık Bilgi Sistemleri Genel Müdürlüğü, Ankara.
  • 17. Horton S, Fleming KA, Kuti M et al. The Top 25 Laboratory Tests by Volume and Revenue in Five Different Countries. American Journal of Clinical Pathology 2019; 151: 446-451.
  • 18. TÜİK. İstatistiklerle Yaşlılar-2019. Haber Bülteni: 18 Mart 2020, Sayı: 33712. https://data.tuik.gov.tr/tr/display-bulletin/?bulletin=istatistiklerle-yaslilar-2019-33712
  • 19. Karakoyun İ, Çolak A, Arslan FD, Akşit MZ, Çakmak O. An Example for Investigation of Unnecessary Laboratory Testing: Free PSA Test. Tepecik Eğit ve Araşt Hast Dergisi 2017; 27: 47-51.
  • 20. Kocatürk E, Canik A, Alataş Ö. Gereksiz Test İstemlerinin sPSA ve Serum Lipidleri Testleri Üzerinden İncelenmesi, Türk Klinik Biyokimya Derg 2015; 13: 101-6.
  • 21. Savaş V, Köken T. Demir Eksikliği Anemisinin Tanısında Gereksiz Test İstemi ve Maliyet Verimliliği, Türk Klinik Biyokimya Derg 2019; 17: 17-22.
  • 22. Çakmak H, Yüksek YN, Tütüncü T, Özer Küçük E, Turhan T, Berker D, Kahveci̇ R. D vitamini testinin akılcı kullanımı: Test mi? Ya da tedavi mi? Turkish Journal of Clinics and Laboratory 2019; 10: 168-78.
  • 23. Chami N, Simons JE, Sweetman A, Don-Wauchope AC. Rates of inappropriate laboratory test utilization in Ontario. Clin Biochem 2017; 50: 822-7.
  • 24. Felcher AH, Gold R, Mosen DM, Stoneburner AB. Decrease in unnecessary vitamin D testing using clinical decision support tools: making it harder to do the wrong thing. J Am Med Inform Assoc 2017; 24: 776-80.
  • 25. Zhao S, Gardner K, Taylor W, Marks E, Goodson N. Vitamin D assessment in primary care: changing patterns of testing. London J Prim Care (Abingdon) 2015; 7: 15-22.
  • 26. Munk JK, Bathum L, Jørgensen HL, Lind BS. A compulsory pop-up form reduces the number of vitamin D requests from general practitioners by 25 percent. Scand J Prim Health Care 2020; 38: 308-14.
  • 27. Sağlık Bilgi Sistemleri Genel Müdürlüğü’nün 24.12.2019 tarihli ve E.9366 sayılı yazısı. https://e-saglik.gov.tr/TR,62238/mukerrerlik-servisi-hk-onemli-duyuru.html
  • 28. Miller CE, Krautscheid P, Baldwin EE, Tvrdik T, Openshaw AS, Hart K, Lagrave D. Genetic counselor review of genetic test orders in a reference laboratory reduces unnecessary testing. Am J Med Genet A 2014; 164: 1094-101.
  • 29. Sağlık Bakanlığı. Tasarruf ve Gelir Artırıcı Projeler Birimi, Etkin laboratuvar kullanımı, 21.07.2020, https://tgap.saglik.gov.tr/TR,54787/etkin-laboratuvar-kullanimi-p2-5-2019-2020.html
  • 30. Lippi G, Bovo C, Ciaccio M. Inappropriateness in laboratory medicine: an elephant in the room? Ann Transl Med 2017; 5: 82.

Use of laboratory tests of public hospitals and cost analysis in Turkey

Year 2021, , 315 - 323, 29.09.2021
https://doi.org/10.18663/tjcl.824967

Abstract

Aim: To analyse usage status of laboratory tests in public hospitals in Turkey by various indicators, and to draw attention to their effect on hospital costs.
Material and Methods: Usage of laboratory tests in public hospitals between 2015-2019, test request ratios, laboratory expenses and medical service data are obtained from the Ministry of Health. Data, which are obtained from various databases of the Ministry of Health, are analysed by being synthesised.
Results: The ratio of laboratory expenses, which increased to 2.7 billion TRY in 2019, is at the level of 5.67% in total costs of public hospitals. As we consider top 25 tests in terms of volume and revenue, we observe that tests are similar in general, and that differences source from high levels of reimbursement rates. We detected that test request ratio and expense per test are high in branch training and research hospitals. The fact that test request ratio is high in provinces where the number of old population and median age is high is in the character of a proof that chronic disease follow-up is a factor that increases the number of test requests. Inappropriate use of laboratory testing (such as vitamin D) create a critical financial burden on hospital costs.
Conclusion: Rational use of laboratory projects must be conducted effectively in order to prevent overuse or unnecessary test requests, which constitute one of the reasons of the continuous increase observed in laboratory expenses in Turkey. Improving the suitability of laboratory tests would not only provide cost effectiveness, but would also provide even more clinical benefits and would make contribution to patient safety.

References

  • 1. TÜİK, Sağlık Harcamaları İstatistikleri-2018. TÜİK Haber Bülteni, 12 Kasım 2019, Sayı: 30624.
  • 2. Konger RL, Ndekwe P, Jones G et al. Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital. Am J Clin Pathol 2016; 145: 355-64.
  • 3. Alonso-Cerezo MC, Martín JS, García Montes MA, de la Iglesia VM. Appropriate utilization of clinical laboratory tests. Clin Chem Lab Med 2009; 47: 1461-5.
  • 4. O'Sullivan JW, Stevens S, Hobbs FDR et al. Temporal trends in use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests. BMJ 2018; 363: 4666.
  • 5. Khalifa M, Khalid P. Reducing Unnecessary Laboratory Testing Using Health Informatics Applications: A Case Study on a Tertiary Care Hospital. Procedia Computer Science 2014; 37: 253-60.
  • 6. Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis. PLOS ONE 2013; 8: 78962.
  • 7. Bindraban RS, Ten Berg MJ, Naaktgeboren CA, Kramer MHH, Van Solinge WW, Nanayakkara PWB. Reducing Test Utilization in Hospital Settings: A Narrative Review. Ann Lab Med. 2018; 38: 402-12.
  • 8. Mrazek C, Simundic, AM, Salinas, M et al. Inappropriate use of laboratory tests: How availability triggers demand-Examples across Europe, Clinica Chimica Acta 2020; 505: 100-7.
  • 9. van Walraven C, Raymond M. Population-based study of repeat laboratory testing. Clin Chem 2003; 49: 1997-2005.
  • 10. Morgen EK, Naugler C. Inappropriate repeats of six common tests in a Canadian city: a population cohort study within a laboratory informatics framework. Am J Clin Pathol 2015; 144: 704-12.
  • 11. Baron JM, Dighe AS. The role of informatics and decision support in utilization management. Clin Chim Acta 2014; 427: 196-201.
  • 12. Fryer AA, Smellie WS. Managing demand for laboratory tests: a laboratory toolkit. J Clin Pathol 2013; 66: 62-72.
  • 13. Janssens PM, Wasser G. Managing laboratory test ordering through test frequency filtering. Clin Chem Lab Med 2013; 51: 1207-15.
  • 14. Ducatman BS, Ducatman AM, Crawford JM, Laposata M, Sanfilippo F. The Value Proposition for Pathologists: A Population Health Approach. Acad Pathol 2020; 7: 1-12.
  • 15. Larsson A, Palmer M, Hultén G, Tryding N. Large Differences in Laboratory Utilisation between Hospitals in Sweden, Clinical Chemistry and Laboratory Medicine, 2000; 38: 383-9.
  • 16. Sağlık Bakanlığı, Sağlık İstatistik Yıllığı-2019, Sağlık Bilgi Sistemleri Genel Müdürlüğü, Ankara.
  • 17. Horton S, Fleming KA, Kuti M et al. The Top 25 Laboratory Tests by Volume and Revenue in Five Different Countries. American Journal of Clinical Pathology 2019; 151: 446-451.
  • 18. TÜİK. İstatistiklerle Yaşlılar-2019. Haber Bülteni: 18 Mart 2020, Sayı: 33712. https://data.tuik.gov.tr/tr/display-bulletin/?bulletin=istatistiklerle-yaslilar-2019-33712
  • 19. Karakoyun İ, Çolak A, Arslan FD, Akşit MZ, Çakmak O. An Example for Investigation of Unnecessary Laboratory Testing: Free PSA Test. Tepecik Eğit ve Araşt Hast Dergisi 2017; 27: 47-51.
  • 20. Kocatürk E, Canik A, Alataş Ö. Gereksiz Test İstemlerinin sPSA ve Serum Lipidleri Testleri Üzerinden İncelenmesi, Türk Klinik Biyokimya Derg 2015; 13: 101-6.
  • 21. Savaş V, Köken T. Demir Eksikliği Anemisinin Tanısında Gereksiz Test İstemi ve Maliyet Verimliliği, Türk Klinik Biyokimya Derg 2019; 17: 17-22.
  • 22. Çakmak H, Yüksek YN, Tütüncü T, Özer Küçük E, Turhan T, Berker D, Kahveci̇ R. D vitamini testinin akılcı kullanımı: Test mi? Ya da tedavi mi? Turkish Journal of Clinics and Laboratory 2019; 10: 168-78.
  • 23. Chami N, Simons JE, Sweetman A, Don-Wauchope AC. Rates of inappropriate laboratory test utilization in Ontario. Clin Biochem 2017; 50: 822-7.
  • 24. Felcher AH, Gold R, Mosen DM, Stoneburner AB. Decrease in unnecessary vitamin D testing using clinical decision support tools: making it harder to do the wrong thing. J Am Med Inform Assoc 2017; 24: 776-80.
  • 25. Zhao S, Gardner K, Taylor W, Marks E, Goodson N. Vitamin D assessment in primary care: changing patterns of testing. London J Prim Care (Abingdon) 2015; 7: 15-22.
  • 26. Munk JK, Bathum L, Jørgensen HL, Lind BS. A compulsory pop-up form reduces the number of vitamin D requests from general practitioners by 25 percent. Scand J Prim Health Care 2020; 38: 308-14.
  • 27. Sağlık Bilgi Sistemleri Genel Müdürlüğü’nün 24.12.2019 tarihli ve E.9366 sayılı yazısı. https://e-saglik.gov.tr/TR,62238/mukerrerlik-servisi-hk-onemli-duyuru.html
  • 28. Miller CE, Krautscheid P, Baldwin EE, Tvrdik T, Openshaw AS, Hart K, Lagrave D. Genetic counselor review of genetic test orders in a reference laboratory reduces unnecessary testing. Am J Med Genet A 2014; 164: 1094-101.
  • 29. Sağlık Bakanlığı. Tasarruf ve Gelir Artırıcı Projeler Birimi, Etkin laboratuvar kullanımı, 21.07.2020, https://tgap.saglik.gov.tr/TR,54787/etkin-laboratuvar-kullanimi-p2-5-2019-2020.html
  • 30. Lippi G, Bovo C, Ciaccio M. Inappropriateness in laboratory medicine: an elephant in the room? Ann Transl Med 2017; 5: 82.
There are 30 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Aziz Küçük 0000-0002-1296-4726

Publication Date September 29, 2021
Published in Issue Year 2021

Cite

APA Küçük, A. (2021). Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanımı ve gider analizi. Turkish Journal of Clinics and Laboratory, 12(3), 315-323. https://doi.org/10.18663/tjcl.824967
AMA Küçük A. Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanımı ve gider analizi. TJCL. September 2021;12(3):315-323. doi:10.18663/tjcl.824967
Chicago Küçük, Aziz. “Türkiye’de Kamu Hastanelerinde Laboratuvar Testlerinin kullanımı Ve Gider Analizi”. Turkish Journal of Clinics and Laboratory 12, no. 3 (September 2021): 315-23. https://doi.org/10.18663/tjcl.824967.
EndNote Küçük A (September 1, 2021) Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanımı ve gider analizi. Turkish Journal of Clinics and Laboratory 12 3 315–323.
IEEE A. Küçük, “Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanımı ve gider analizi”, TJCL, vol. 12, no. 3, pp. 315–323, 2021, doi: 10.18663/tjcl.824967.
ISNAD Küçük, Aziz. “Türkiye’de Kamu Hastanelerinde Laboratuvar Testlerinin kullanımı Ve Gider Analizi”. Turkish Journal of Clinics and Laboratory 12/3 (September 2021), 315-323. https://doi.org/10.18663/tjcl.824967.
JAMA Küçük A. Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanımı ve gider analizi. TJCL. 2021;12:315–323.
MLA Küçük, Aziz. “Türkiye’de Kamu Hastanelerinde Laboratuvar Testlerinin kullanımı Ve Gider Analizi”. Turkish Journal of Clinics and Laboratory, vol. 12, no. 3, 2021, pp. 315-23, doi:10.18663/tjcl.824967.
Vancouver Küçük A. Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanımı ve gider analizi. TJCL. 2021;12(3):315-23.


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