COVİD-19 PANDEMİSİNİN HASTANE MALİYETLERİNE ETKİSİ: BİR EĞİTİM VE ARAŞTIRMA HASTANESİ ÖRNEĞİ

Öz

Bu çalışmada, bir eğitim ve araştırma hastanesine COVID-19 tanısı ile yatırılmış olan hastalara sunulan sağlık hizmetlerinin maliyetinin belirlenmesi amaçlanmıştır. Çalışmada, Mart-Haziran 2020 arasında COVID-19 tanısı ile hastaneye yatırılmış olan hastaların dosyaları, mali kayıtları retrospektif olarak incelenmiş ve değerlendirilmiştir. Hastaların demografik, klinik ve maliyet bilgileri excel ortamına aktarılarak analiz edilmiştir. Hastaların 203’ü (%55) erkek, 163’ü (%45) kadındır. Hastaların yaşa göre dağılımında %39,07 ile en büyük grubu 25-49 yaş arası hastalar oluşturmaktadır. COVID-19 tanısı almış 366 hastadan 165’inde riskli ek hastalık saptanmıştır. Hipertansiyon 105 (%33,98) hastada görülürken, kalp ve damar hastalıkları 56 (%18,12) hastada, diyabetes mellitüs 56 (%18,12) hastada ve akciğer hastalıkları 51 (%16,51) hastada görülmüştür. Hastanede tüm hastalar için ortalama yatış süresi 8 gün olarak hesaplanmıştır. Sigara içme durumlarına göre sınıflandırılan 366 hastanın 239 (%65,3)’u hiç sigara kullanmamıştır. COVID-19 hastane harcamalarının en büyük harcama kalemini 1.658.238,45 TL (%68,62) ile pandemi bakım hizmeti oluşturmuştur. Harcama tutarının diğer önemli kısmını ise 401.403,08 TL (%16,61) ile yoğun bakım maliyeti oluşturmuştur. COVID-19 tanısı almış hastaların tedavi maliyetleri, hastaların cinsiyetine, yaşına, riskli hastalık sayısına, yatış süresine, sigara içme durumlarına ve sigara içip aynı zamanda riskli hastalığa sahip olup olmama durumlarına göre farklılık göstermiştir. Bu araştırmanın, etkili kararların verilmesi ve hasta tedavilerinin planlanmasında, aşılama programlarının öneminin anlaşılmasında, riskli hastalıkları önleme programlarının uygulanmasında, hastane maliyetlerinin yönetilmesinde sağlık yöneticilerine, sağlık politikacılarına ve daha kapsamlı araştırmaların yapılması konusunda araştırmacılara yol gösterici olacağı düşünülmektedir.

Anahtar Kelimeler

• COVID-19
• hastane maliyetleri
• sağlık hizmetleri yönetimi.

THE EFFECT OF THE COVID-19 PANDEMİC ON HOSPİTAL COSTS: A TRAİNİNG AND RESEARCH HOSPİTAL EXAMPLE

Öz

In this study, it was aimed to determine the cost of health services provided to patients hospitalized with the diagnosis of COVID-19 in a training and research hospital. In the study, the files and financial records of patients who were hospitalized with the diagnosis of COVID-19 between March and June 2020 were retrospectively reviewed and evaluated. Demographic, clinical and cost information of the patients were analyzed by transferring them to excel. Of the patients, 203 (55%) were male and 163 (45%) were female. In the distribution of patients by age, the largest group is composed of patients aged 25-49 with 39.07%. Additional risky diseases were detected in 165 of 366 patients diagnosed with COVID-19. While hypertension was observed in 105 (33.98%) patients, cardiovascular diseases were observed in 56 (18.12%) patients, diabetes mellitus was observed in 56 (18.12%) patients, and lung diseases were observed in 51 (16.51%) patients. The average length of stay in the hospital was calculated as 8 days for all patients. Of 366 patients classified according to their smoking status, 239 (65.3%) never smoked. The largest expenditure item of COVID-19 hospital expenditures was the pandemic care service with 1,658,238.45 TL (68,62%). Another important part of the expenditure amount was the intensive care cost with 401.403.08 TL (16.61%). The treatment costs of patients diagnosed with COVID-19 differed according to the gender, age, number of risky diseases, length of stay, smoking status, and whether they smoke and also have a risky disease. It is thought that this research will guide health administrators and health politicians in making effective decisions and planning patient treatments, understanding the importance of vaccination programs, implementing risky disease prevention programs and managing hospital costs. It is also thought that it will guide researchers in conducting more comprehensive research.

Anahtar Kelimeler

• COVID-19
• hospital costs
• healthcare management.

Kaynakça

1. AHA (2020, June 14). Hospitals and health systems face unprecedented financial pressures due to COVID 19. https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due
2. Akalın, E., Tanrıöver, M. D., Sayran, F (2012). Sürdürülebilir sağlık sistemi için kronik hastalık yönetiminde elektronik sağlık kayıtlarının rolü, Haziran 2012. Yayın No: TÜSİAD-T/2012-06/529.
3. Bartsch, S. M., Ferguson, M. C., Mckinnell, J. A., O’Shea, K. J., Wedlock, P. T., Siegmund, S. S., & Lee, B. Y. (2020). The potential health care costs and resource use associated with COVID-19 in the United States. Health Affairs, 39(6), 927-935. https://doi.org/10.1377/hlthaff.2020.00426
4. Best, J. H., Mohan, S. V., Kong, A. M., Patel, K., Pagel, J. M., Ivanov, B., Brawley, O. W., Parikh, K. J., Zazzali, J. L., & Pauk, J. (2020). Baseline demographics and clinical characteristics among 3471 US patients hospitalized with COVID-19 and pulmonary involvement: a retrospective study. Advances in Therapy, 37, 4981-4995. https://doi.org/10.1007/s12325-020-01510-y
5. Brown, E. E., Kumar, S., Rajji, T. K., Pollock, B. G., & Mulsant, B. H. (2020). Anticipating and mitigating the impact of the COVID-19 pandemic on alzheimer’s disease and related dementias. The American Journal of Geriatric Psychiatry, 28(7), 712-721. https://doi.org/10.1016/j.jagp.2020.04.010
6. Cummings, M. J., Baldwin, M. R., Abrams, D., Jacobson, S. D., Meyer, B. J., Balough, E. M., Aaron, J. G., Claassen, J., Rabbani, L. E., Hastie, J., Hochman, B. R., Schicchi, J. S., Yip, N. H., Brodie, D., & O'Donnell, M. R. (2020). Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet, 395(10239), s1763-1770. https://doi.org/10.1016/ S0140-6736(20)31189-2
7. Ekingen, E., Yıldız, A. (2021). Türkiye’de COVID-19 tedavi maliyetleri: Sosyal güvenlik kurumuna yükü ve belirleyicileri. İktisadi İdari ve Siyasal Araştırmalar Dergisi, 6(15), 262-270. https://doi.org/10.25204/iktisad.844714
8. Fusco, M. D., Shea, K. M., Lin, J., Nguyen, J. L., Angulo, F. J., Benigno, M., Malhotra, D., Emir, B., Sung, A. H., Hammond, J. L., Stoychev, S., & Charos, A. (2021). Health outcomes and economic burden of hospitalized COVID-19 patients in the United States. Journal of Medical Economics, 24(1), 308-317. https://doi.org/10.1080/13696998.2021.1886109

9. Grant, M. C., Geoghegan, L., Arbyn, M., Mohammed, Z., McGuinness, L., Clarke, E. L., & Wade, R. G. (2020). The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries. PLoS One, 15(6), e0234765. https://doi.org/10.1371/journal.pone.0234765
10. Guan, W., Ni, Z., Y., Hu, Y., Liang, W., Ou, C., He, J., Liu, L., Shan, H., Lei, C., Hui, D. S. C., Du, B., Li, L., Zeng, G., Yuen, K. Y., Chen, R., Tang, C., Wang, T., Chen, P., Xiang, J., Li, S., Wang, J., Liang, Z., Peng, Y., Wei, L., Liu, Y., Hu, Y., Peng, P., Wang, J., Liu, J., Chen, Z., Li, G., Zheng, Z., Qiu, S., Luo, J., Ye, C., Zhu, S., & Zhong, N. (2020). Clinical characteristics of coronavirus disease 2019 in China. The New England Journal of Medicine, 382:1708-1720. https://10.1056/NEJMoa2002032
11. Hatef, E., Chang, H. Y., Kitchen, C., Weiner, J. P., & Kharrazi, H. (2020). Assessing the impact of neighborhood socioeconomic characteristics on COVID-19 prevalence across seven states in the United States. Front Public Health. 8:571808. https://10.3389/fpubh.2020.571808
12. Grimm, C. A. (2020, June 30). Hospital experiences responding to the COVID-19 pandemic: results of a national pulse survey march 23-27, 2020. Washington, DC: U.S. Department of Health and Human Services, Office of the Inspector General. https://catalog.libraries.psu.edu/catalog/30281747
13. Jang, S., Y., Seon, J. Y., Yoon, S. J., Park, S. Y., Lee, S. H., & Oh, I. H. (2021). Comorbidities and factors determining medical expenses and length of stay for admitted COVID-19 patients in Korea. Risk Management and Healthcare Policy, 14, 2021-2033. https://doi.org/10.2147/RMHP.S292538
14. Johns Hopkins Medicine (2021, February 22). Coronavirus COVID-19 (SARS-CoV-2). https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_
15. Kavalcı, G. (2021). Comparison of the treatment cost of COVID-19 and non-COVID-19 patients in the intensive care unit. Erciyes Medical Journal, 43(4), 393-396. https://doi.org/10.14744/etd.2020.97572
16. Khullar, D., Bond, A. M., & Schpero, W. L. (2020). COVID-19 and the financial health of us hospitals, Journal of the American Medical Association, 323(21), 2127-2128. https://doi.org/10.1001/jama.2020.6269
17. Lawrence, H., Hunter, A., Murray, R., Lim, W. S., & McKeever, T. (2019). Cigarette smoking and the occurrence of influenza - systematic review. Journal of Infection, 79(5), 401-406. https://doi.org/10.1016/j.jinf.2019.08.014
18. Miller, I. F., Becker, A. D., Grenfell, B.T., & Metcalf, C. J. E. (2020). Disease and healthcare burden of COVID-19 in the United States. Nature Medicine, 26, 1212-1217. https://doi.org/10.1038/s41591-020-0952-y
19. Morais, A. M., Cassenote, A., Piva, H., Takunaga, E., Cobello V., Gonçalves F., A., R., G., Lobo, R., A., S., Trindade, E., D`Albuquerque, L., A., C., & Haddad, L., B., P. (2020). Unraveling COVID-19-related hospital costs: the impact of clinical and demographic conditions. MedRxiv, 1-25. https://www.medrxiv.org/content/medrxiv/early/2020/12/30/2020.12.24.20248633.full.pdf
20. Nicola, M., Alsafi, Z., Sohrabi, C., Kerwan, A., Al-Jabir, A., Losifidis, C., Agha, M., & Agha, R. (2020). The socio-economic implications of the coronavirus pandemic (COVID-19): A review. International Journal of Surgery, 78, 185-193. https://doi.org/10.1016/j.ijsu.2020.04.018
21. Orhaner, E (2014). Türkiye’de Sağlık Sigortası, Siyasal Kitabevi, 1. Baskı, Eylül 2014.
22. Potere, N., Valeriani, E., Candeloro, M., Tana, M., Porreca, E., Abbate, A., Spoto, S., Rutjes, A. W. S., & Nisio, M. D. (2020). Acute complications and mortality in hospitalized patients with coronavirus disease 2019: A systematic review and meta-analysis. Critical Care., 24: 389. https://doi.org/10.1186/s13054-020-03022-1
23. Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn T, & Davidson, K. W. (2020). Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. Journal of the American Medical Association. 323(20), 2052-2059. https://doi.org/10.1001/jama.2020.6775
24. SAĞLIK BAKANLIĞI (2008). Türkiye kalp ve damar hastalıklarını önleme ve kontrol programı. Risk Faktörlerine Yönelik Stratejik Plan ve Eylem Planı. Sağlık Bakanlığı Yayın No:743.
25. SAĞLIK BAKANLIĞI (2020, 27 Haziran). COVID-19 (Sars-Cov-2 Enfeksiyonu): Genel Bilgiler, Epidemioloji ve Tanı, Bilimsel Danışma Kurulu Çalışması. https://covid19bilgi.saglik.gov.tr/tr/covid-19-rehberi.html
26. SAĞLIK BAKANLIĞI (2021, 25 Mayıs). COVID-19 Bilgilendirme Platformu. Türkiye Günlük Koronavirüs Tablosu. https://covid19.saglik.gov.tr/
27. Thai, P. Q., Toan, D. T. T., Son, D., T., Van, H. T. H., Minh, L. N., Hung, L. X., Toan, N. V., Hoat, L. N., Luong, D. H., Khue, L. N., Khoa, N. T., & Huong, L. T. (2020). Factors associated with the duration of hospitalisation among COVID-19 patients in vietnam: a survival analysis. Epidemiology and Infection. 148(114), 1-7. https://doi.org/10.1017/S0950268820001259
28. TÜİK (2021, 14 Haziran). Sağlık Harcamaları İstatistikleri, 2019. Haber Bülteni. https://data.tuik.gov.tr/Bulten/Index?p= Health-Expenditure-Statistics-2019-33659
29. TÜSAP (2021, 5 Mart). COVID-19’un Türkiye sağlık ekonomisi üzerindeki mali yükü, TÜSAP COVID-19 Tedavisinin Ekonomik Yükü Sağlık Finansmanı Raporu. https://tusap.org/wp-content/uploads/2021/09/2021_2-TOPLANTI.pdf
30. Tzotzos, S. J., Fischer, B., Fischer, H., & Zeitlinger, M. (2020). Incidence of ARDS and outcomes in hospitalized patients with COVID-19: A global literature survey. Critical Care, 24: 516. https://doi.org/10.1186/s13054-020-03240-7
31. WHO (2008). 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, http://whqlibdoc.who.int/publications/2009/9789241597418_eng.pdf
32. WHO (2020a, May 25). Novel Coronavirüs (2019-nCov) Situation Report-1. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
33. WHO (2020b, June 14). Coronavirus Disease 2019 (COVID-19) Situation Report- 51. https://apps.who.int/iris/handle/10665/331475
34. WHO (2021, May 30). Weekly Operational Update on COVID-19 - 24 May 2021. https://www.who.int/publications/m/item/weekly-operational-update-on-covid-19---24-may-2021