Next Step in Cost Containment of Public Hospital Economy Could Be Merging of Anesthesia and Surgery Budgets

Public hospitals are typically run by diagnosis-related groups (DRG) as income. There is, however, a major problem in that medical reimbursement per patient is dropping and at the same time the surgery-related costs have increased remarkably in recent years. It is therefore necessary to optimize income as well as reduce expenses as much as possible. The major part of the expenses for a patient undergoing, e.g., laparoscopic rectal resection is divided by the intervention stage covering approximately 50% of the total expenses and the ward stay covering approximately 35% of the total expenses (1). It is therefore natural to focus on lowering ward stay as well as looking at cost containment during surgery and anesthesia. There are ongoing efforts to reduce ward stay in for instance optimized care regimens, so called fast-track surgery, and recently in the setting of the Perioperative Surgical Home that employs close collaboration between anesthesiology, surgery and nursing in order to send the patient home as early as possible in good shape. Only a very small amount is spent on anesthesia drugs, whereas about 20 times more are spent on surgical devices (1). Thus, the total intervention stage expense for a laparoscopic rectal resection was 5,491 Euro where anesthesia only cost 123 Euro, and surgical devices cost 2,361 Euro (1). It is therefore important to negotiate better prices for surgical single use equipment, whereas a slight increase in anesthesia expense would not make a big difference to the overall budget. Thus, if anesthesia expenses would be increased in order to get the patients out of the operating room faster, then it would not matter much for the overall calculations and it would in the end be possible to run an extra case in that operating room. An example of this is the use of sugammadex for reversal of muscle relaxation in general anesthesia where the patient will be out of relaxation and anesthesia extremely fast, and thereby makes it possible to perform an extra surgical case if properly managed. Thus, a study (2) and a recent health economic assessment (3) have shown that there may be an overall economic benefit, even when spending more money on general anesthesia. In line with this, it is evident that inefficient scheduling of operating room time resulting in delays of surgery and even in cancelations will be very costly for the hospital (4) and especially turn over time between cases …