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

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

1. 1. WHO: Ageing and Life Course. [updated 2017; cited 29 July 2017) Available from:http://www.who.int/ageing/en/
2. 2. Sağlık Bakanlığı: Sağlık İstatistikleri Yıllığı 2015 [updated 2015; cited 30 July 2017] Available from: http://www.saglikistatistikleri.gov.tr/dosyalar/SIY_2015.pdf
3. 3. TUİK: Doğuşta Beklenen Yaşam [updated 2017; cited 30 July 2017] Available from: www.tuik.gov.tr/PdfGetir.do?id=21509
4. 4. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med 2010; 182(4):446-54.
5. 5. WHO: The top 10 causes of death [updated 2017; cited 29 July 2017] Available from: http://www.who.int/mediacentre/factsheets/fs310/en/
6. 6. WHO: NCD mortality and morbidity [updated 2017; cited 29 July 2017] Available from: http://www.who.int/gho/ncd/mortality_morbidity/en/
7. 7. Milbrandt EB, Kersten A, Rahim MT, Dremsizov TT, Clermont G, Cooper LM, Angus DC, Linde-Zwirble WT. Growth of intensive care unit resource use and its estimated cost in Medicare. Crit Care Med 2008; 36(9):2504-10.
8. 8. Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, Fowler RA, Meyfroidt G, Nakagawa S, Pelosi P et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2017; 37:270-6.

9. 9. Valentin A, Ferdinande P. Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive care med 2011; 37(10):1575-1587.
10. 10. Liu K, Baseggio C, Wissoker D, Maxwell S, Haley J, Long S. Long-term care hospitals under Medicare: facility-level characteristics. Health Care Financ Rev 2001; 23(2):1-18.
11. 11. Loss SH, Marchese CB, Boniatti MM, Wawrzeniak IC, Oliveira RP, Nunes LN, Victorino JA. Prediction of chronic critical illness in a general intensive care unit. Rev Assoc Med Bras (1992) 2013; 59(3):241-7.
12. 12. Macintyre NR: Chronic critical illness: the growing challenge to health care. Respir care 2012; 57(6):1021-7.
13. 13. Koranne R. The role of the long-term acute care hospital. Minn med 2011; 94(9):38-40.
14. 14. What are Long-Term Care Hospitals? [updated 2017; cited 29 July 2017] Available from:
15. 15. Long-term care hospital [updated 2017; cited 30 July 2017] Available from: https://www.medicare.gov/Pubs/pdf/11347.pdf
16. 16. Seneff MG, Wagner D, Thompson D, Honeycutt C, Silver MR. The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation. Crit care med 2000; 28(2):342-50.
17. 17. Munoz-Price LS. Long-term acute care hospitals. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2009; 49(3):438-43.
18. 18. Votto JJ, Scalise PJ, Barton RW, Vogel CA: An analysis of clinical outcomes and costs of a long term acute care hospital. J Med Econ 2011; 14(2):141-6.
19. 19. SGK: Mevzuat [updated 2017; cited 29 July 2017] Available from: http://www.mevzuat.gov.tr/Metin.Aspx?MevzuatKod=9.5.17229&MevzuatIliski=0&sourceXml
20. 20. Kahn JM, Benson NM, Appleby D, Carson SS, Iwashyna TJ. Long-term acute care hospital utilization after critical illness. Jama 2010, 303(22):2253-2259.
21. 21. Szubski CR, Tellez A, Klika AK, Xu M, Kattan MW, Guzman JA, Barsoum WK. Predicting discharge to a long-term acute care hospital after admission to an intensive care unit. American journal of critical care : an official publication. Am J Crit Care 2014, 23(4):e46-53.
22. 22. TKHK: Yoğun Bakım Üniteleri Araştırması [updated 2017; cited 30 July 2017] Available from: http://www.tkhk.gov.tr/3355_yogun-bakim-uniteler
23. 23. Rimachi R, Vincent JL, Brimioulle S. Survival and quality of life after prolonged intensive care unit stay. Anaesth Intensive Care 2007; 35(1):62-7.
24. 24. Carson SS. Know your long-term care hospital. Chest 2007; 131(1):2-5. 25. Kahn JM, Werner RM, David G, Ten Have TR, Benson NM, Asch DA. Effectiveness of long-term acute care hospitalization in elderly patients with chronic critical illness. Med Care 2013; 51(1):4-10.