Uzun Süreli Yoğun Bakım, Sağlık Harcamalarının Düşürülmesine Katkı Sağlar mı?

Yıl 2017, Cilt: 7 Sayı: 4, 378 - 384, 15.11.2017

Metin Dinçer Kadriye Kahveci

https://doi.org/10.16899/gopctd.353341

Öz

Amaç: Ülkemizde nüfusun giderek yaşlanması kronik hastalıkları artırmıştır. Bu artışla birlikte hem yoğun bakım (YB) ihtiyacı hem de sağlık harcamaları artmıştır.  Bu çalışmanın amacı; Ülkemizde uzun süreli YB’de (USYB) yatan hastalar için, sürdürülebilir sağlık politikalarının hazırlanmasına ve sağlık hizmetleri planlamasına katkı sağlamaktır.

Yöntem: 2. Basamak Hastane (BH) 3. Seviye YB ünitesinde (3. SYBÜ)’de yatan hastaların kayıtları retrospektif olarak incelendi. Çalışmaya alınan 717 hastanın her biri için, yaş, cinsiyet, klinik durumları, YBÜ’de yatış süresi, prognozları ve Sağlık Uygulama Tebliği (SUT) ilkelerine göre 2. BH oluşan fatura bedelleri kaydedildi. Daha sonra her bir hasta için bire bir aynı koşullar altında, aynı hizmetler 3. BH’ 3.SYBÜ’de verilmiş olsaydı, fatura edilebilecek bedeli belirlemek için teorik hesaplamalar yapıldı.

Bulgular: Hastaların yaş ortancası 76.0 yıl, 2. BH 3.SYBÜ’de yatış gün ortancası 28.0 gündü. Bu hastaların % 84.4 3.SYBÜ’de yatarken ölmüştür. Verilen hizmetler için Sosyal Güvenlik Kurumu’na (SGK) fatura edilebilecek tutarlar 1.156,90-569.590,66 TL olarak belirlenmiştir. Aynı hastaların, 3. BH’de yer alan 3. SYBÜ’de kaldıkları varsayıldığında SGK’ya fatura edilebilecek tutarların ise 1.250,02 – 624.333,35 TL olacağı hesaplanmıştır. Hastaların 2. BH 3.SYBÜ tedavi edilmeleri hasta başına ortalama 1.932,29 TL az ödemeye ve toplam 717 hastada, 2.721.225,27 TL az ödemeye neden olabileceğini gösterilmiştir. 

Sonuç: 3. BH deki hastaların 2. BH 3.SYBÜ’ne nakledilmesi, bu yatakların akut bakım ihtiyacı olan ve prognozu iyi olabilecek hastalara ayrılmasına ve bu sayede bu hizmetlere ayrılan kaynakların daha etkin ve verimli kullanılmasına olanak sağlayacaktır. Bu nedenlerle USYB hastanelerinin kavramsal olarak, tartışılmalı ve hayata geçirilmelidir.

Anahtar Kelimeler

Kronik Kritik Hastalık, Uzun Süreli Yoğun Bakım, Sağlık Harcaması

Can Long-Term Intensive Care Make a Contribution to the Reduction of Healthcare Costs?

Öz

Aim: As the ageing population of Turkey increases, so there is an increase in chronic diseases, resulting in an increase in both the need for intensive care (IC) and healthcare expenditure. The aim of this study was to contribute to the preparation of sustainable healthcare policies for long-term IC patients and to the planning of healthcare services. 

Method: A retrospective examination was made of the records of patients in a level 3 IC unit (ICU) in a level 2 hospital. For each of the 717 patients included in the study, a record was made of the age, gender, clinical status, length of stay in ICU, prognosis and the hospital bill according to the principles of the Healthcare Application Declaration. Then a theoretical calculation was made for each patient of the same services under the same conditions in a level 3 ICU in a level 3 hospital. 

Results: The mean age of patients was 76.0 years and mean length of stay in the level 3 ICU of the level 2 hospital was 28.0 days. The mortality rate in ICU of these patients was 84.4%. The costs of the healthcare services which could be billed to the National Social Services were 1,156.90 TL – 569,590.66 TL. If the same patients had been admitted and treated in a level 3 ICU of a level 3 hospital, the charges which could be billed to Social Services were calculated as 1,250.02 TL – 624,333.35 TL. The treatment of patients in a level 3 ICU in level 2 hospitals showed a mean lower cost of 1,932.29 TL per patient and a total saving of 2,721,225.27 for the total 717 patients. 

Conclusion:  The transfer of patients in a level 3 hospital to a level 3 ICU in a level 2 hospital allows those beds to be used for those in need of acute care and differentiates patients who could have a good prognosis, and the resources allocated for these services can be used in a more effective and productive way. Therefore, the concept of long-term, intensive care hospitals should be discussed and implemented. 

Anahtar Kelimeler

Chronic Critical İllness, Long Term Intensive Care, Health Expenditure

Kaynakça

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