2003, Number 4
Salud Mental 2003; 26 (4)
Costos de hospitalización por farmacodependencia para población no asegurada en México
Parada-Toro I, Arredondo-López A, Arjonilla-Alday S
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ABSTRACTOne aspect related to health system planning and operation is economic analysis at the different medical care levels. Economic analysis incorporation is intended to help improve supplied service efficiency and effectiveness. Economic analysis is increasing in the health field, and one highly developing area is cost evaluation per specific demand (i.e. per illness type).
Drug dependency is precisely one specific health problem with increasing demand in terms of quantity as well as addiction types, complexity, treatment and rehabilitation services duration. Within this context of increased medical care costs and increased service demand for drug dependent patients, this study intends to analyze hospital care costs for the non-insured population attended to in Youth Integration Centers (Centros de Integración Juvenil—CIJ).
Background. CIJ data reported at the national level indicates alarming evolution between 1990 and 1995. In 1990, one of every 12 CIJ attended patients, had used drugs at least one time during their life (OT), while by 1995, one of every three patients had tried drugs. By these same years, 21 of the 54 regional centers reported higher OT consumption percentages than the 32.4% national average. Drug dependency hospitalization cost analysis will provide a very useful tool for intervention and program evaluation and planning, as well as organizational level decisionmaking and policy and research planning to address the problem.
Material and methods. The present is a transversal study during 1997-1998 in CIJ in-patient units in the states of Baja California (Tijuana) and Jalisco (Zapopan), comparing the two centers’ institutional level costs and users’ service costs. Data was obtained through CIJ secondary registries in the CIJ Mexico City central office, and include users’ socio-economic data, service use, hospitalization treatment type, and cost. The study integrates all users treated over the study period by both centers. Economic methodology used for the calculation is based on CIJ direct hospitalization costs’ main determinants, related firstly to the medical practice, and secondly to service management or administration. The first case includes the medical procedure itself, direct inputs such as medications, and auxiliary services such as number and type of exams undertaken. The second case refers to internal organizational systems. In this case, analysis was undertaken considering by hospitalization motives, through evaluation of care protocols, and specific human resource hours employed: physicians, nurses, social workers, administrative personnel, etc. Administrative personnel time was calculated pro rata for each: director, under-director, etc. Input costs such as for medications and laboratory exams were adjusted equivalent toindividual user direct market costs or institutional consolidated purchase costs.
Results. Institutionally established cost recovery quotas range between 1.10, 2.37 and 4.21 dollars day/bed, according to the socio-economic study. Nevertheless, many patients were exempted from payment due to their economic condition. Users’ day/bed average institutional cost is 30.96 dollars. Complete hospitalization treatment costs for users in both centers was 765.40 dollars for 30-day treatments and 2,782.70 for 90-day treatments. Both periods include: medical care; detoxification; psychiatric treatment; individual and group psychological therapy, and occupational and family therapy. Institutional costs calculated for the centers were, in Tijuana: 7,940.30 dollars for 30-day treatment, and 23,822.30 dollars for 90-day treatment. Zapopan CIJ costs were: 7,654.40 dollars for 30-day treatment and 22,900.10 dollars for 90-day treatment. User recovery quotas received in 1997 in Zapopan were 8,294.11 dollars, with a per-patient average of 47.4 dollars. Quotas received in 1997 in Tijuana totaled 8,969.22 dollars, with a per-patient average of 68.46 dollars. Thirty-day hospitalization treatment costs the public sector ten times more than the real user cost in Tijuana and eight times more than in Zapopan. Public sector institutional costs for 90-day treatment increase between 60 and 70 percent for both care centers. Reported coverage in Tijuana was 131 patients, and 175 patients in Zapopan. Upon calculating the period’s occupation (75%), 47% and 63% occupation were calculated in Tijuana and Zapopan respectively, based on the assumption of 30-day treatments. With 90-day treatments, these centers would have presented 142.39% and 190.21% reported coverage for the year.
Discussion. Patient cost for 30-day treatment amounts to seven monthly minimum wages, and to 21 monthly minimum wages for 90-day treatment. The type of patients demanding care — generally characterized by low or middle socio-economic conditions and often unemployed or with variable income— indicate a risk of lack of economic access to treatment. In regard to availability offered by both centers, 560 days/bed availability is required for 30-day treatments and 187 days/bed availability is required for 90-day treatments. This suggests that the centers lack sufficient beds to satisfy continually increasing population demand for drug dependency treatment. Yearly occupation calculations, with a 75% occupation rate and taking into account treatment duration, indicate that each center may provide 30-day treatments to 207 patients. Capacity would be limited to 69 patients in the case of 90-day treatments. If we analyze these figures in relation to CIJ costs, we find the public sector would need to invest 1,643,737 dollars per year and 1,584,456 dollars per year to meet demand for 30 and 90-day treatments respectively. Total public sector investment should therefore be 3,228,193 dollars (total amount for both centers). However, according to CIJ reported data, the public sector invested a total of 2,941,180 dollars for drug dependency treatment in both sectors during 1997-1998, assuming 75% occupation during the period. This indicates that despite strong public sector investment, the rehabilitation and hospitalization program does not meet existing demand. Another study finding was that recovery quotas established for users correspond to 11.63% in Tijuana and 12.31% in Zapopan with respect to public sector investment to satisfy this type of demand. We consider recovery quotas insufficient to cover treatment operation costs. However, considering the current economic dynamics and the service’s target population, and if we add the economic burdens borne by drug dependent CIJ users’ families, CIJ service demand would probably diminish if treatment cost payment were adjusted to these new health policies. This leads us to question why the treatment centers present such low occupation and demand, despite the phenomenon’s increasing dynamics both in consumption and in service demand, when it is supposed that those who can not afford to pay are not required to do so. Are these low occupation and demand rates due to insufficient information on CIJ services, deficient socio-economic studies, or to characteristics of the problem itself ? We conclude by noting that the problem’s impact on individual economic, social or productive output can not be ignored. This impact may be measured in “lost” time or life years, which in turn represent, as an indicator or the illness’s burden, the hospitalization confinement events generated by drug use. Lost time calculations would also help establish the cost borne by government and society for this type of treatment until the individual’s resumed incorporation within social and economic life.