INTRODUCTION
Once an admirable model of universal healthcare, the Spanish public
system suffered a severe financial downturn at the time of the last
recession with repercussions at multiple levels. In addition to
provision of basic health services, health outcomes of population were
affected in a system already strained by many years of structural and
financial debts and perpetually slanted toward acute inpatient care
[1,2]. Yet public authorities did not take the opportunity to
reorganize and improve public healthcare services and lessen the
financial burden, with some notable exception. The realization that
hospitalizations and hospital care were one leading cause of excessive
healthcare expenses opened the way for a shift from traditional
‘bed-based’ inpatient care to hospital-based ambulatory and outpatient
care services [3,4]. A systematic review recently published inJAMA Internal Medicine showed that alternative ambulatory
approaches to inpatient care for patients with medical conditions were
associated, as compared to traditional inpatient admission, with similar
health outcomes and similar or higher patient-reported satisfaction
levels but at significantly lower costs [5]. These alternative
models for conditions conventionally designed to require hospitalization
include, to mention a few, observation units, hospital-at-home, daycare
hospitals, and
quick
diagnosis units. While the former were developed decades ago and
extended to additional medical conditions in recent years,
quick diagnosis units became a new
paradigm of innovation in hospital
ambulatory medicine in the 2000s [3-5]. By sidestepping unnecessary
and expensive admissions for purely diagnostic purposes, today these
units represent a well-established healthcare delivery model conceived
to achieve quick diagnoses for patients complaining of potentially
severe diseases, most notably cancer [5-8].
Although limited, available reported data suggest that the quick
diagnosis unit approach may be cost-effective. Studies evaluating the
cost outcomes of these units have been reported as non-comparative cost
analyses of single units [9,10] or with the standpoint of comparing
the costs of these patients with those of inpatients hospitalized for
the same condition [11-13]. These investigations have been valuable
for the objective assessment of the actual costs incurred by quick
diagnosis units of single centers.
However, how cost outcomes compare
between units of different hospitals is unknown. Such cost-comparison
evaluation could add a broader and useful perspective to the economic
potential of these units within the new model of hospital ambulatory
medicine and hospital-based care in general.
The objective of this study was to
investigate the costs incurred by patients with potentially severe
diseases managed at two quick diagnosis units
of hospitals with different levels
of complexity in Barcelona. A
micro-costing analysis based on
resource consumption data from the two centers was applied.