Advertisement

Intensive Care Medicine

, Volume 30, Issue 4, pp 660–664 | Cite as

Economies of scale in British intensive care units and combined intensive care/high dependency units

  • Philip JacobsEmail author
  • John Rapoport
  • David Edbrooke
Original

Abstract

Objective

To estimate the relationship between size of intensive care unit and combined intensive care/high dependency units and average costs per patient day.

Design

Retrospective data analysis. Multiple regression of average costs on critical care unit size, controlling for teaching status, type of unit, occupancy rate and average length of stay.

Setting

Seventy-two United Kingdom adult intensive care and combined intensive care/high dependency units submitting expenditure data for the financial year 2000–2001 as part of the Critical Care National Cost Block Programme.

Interventions

None.

Measurements and results

The main outcome measures were total cost per patient day and the following components: staffing cost, consumables cost and clinical support services costs. Nursing Whole Time Equivalents per patient day were recorded. The unit size variable has a negative and statistically significant (p<0.05) coefficient in regressions for total, staffing and consumables cost. The predicted average cost for a seven-bed unit is about 96% of that predicted for a six-bed critical care unit.

Conclusion

Policy makers should consider the possibility of economies of scale in planning intensive care and combined intensive care/high dependency units.

Keywords

Cost and cost analysis Intensive care units 

References

  1. 1.
    Gyldmark M (1995) A review of cost studies of intensive care units: problems with the cost concept. Crit Care Med 23:964–972PubMedGoogle Scholar
  2. 2.
    Metcalfe A, McPherson K (1995) Study of provision of intensive care in England, 1993: revised report for Department of Health—January 1995. Report for Department of HealthGoogle Scholar
  3. 3.
    National Confidential Enquiry into Perioperative Deaths (NCEPOD) (2000). Functioning as a team: the 2002 report of the National Confidential Enquiry into Perioperative Deaths. NCEPOD, LondonGoogle Scholar
  4. 4.
    Audit Commission (1999) Critical to success: national report. Audit Commission, LondonGoogle Scholar
  5. 5.
    Department of Health (2000) Comprehensive critical care: a review of adult critical care services. DOH, London. www.doh.gov.uk/nhsexec/compcritcare.htm. Accessed 15 August 2003Google Scholar
  6. 6.
    Groeger JS, Strosberg MA, Halpern NA, Raphaely RC, Kaye WE, Guntupalli KK, Bertram DL, Greenbaum DM, Clemmer TP, Gallagher TJ et al. (1992) Descriptive analysis of critical care units in the United States. Crit Care Med 20:846–863Google Scholar
  7. 7.
    Long MJ, Ament RP, Dreachslin JL, Kobrinski EJ (1985) A reconsideration of economies of scale in the health care field. Health Policy 5:25–44Google Scholar
  8. 8.
    Chang C, Tuckman HP (1986) Will economies of scale always reduce cost? An economic analysis of the effects of hospital expansion. J Health Hum Resources Admin 8:249–261Google Scholar
  9. 9.
    Tibi-Levy Y, de Pouvourville G, Rozenholc Y, Goursot G, Clergue F, Delemontey B, Feiss P, Laxenaire MC, Marty J, Beresniak A (1998) Evaluation of benefits related to reduced length of stays in postanesthesia care units. Int J Technol Assess Health Care 14:172–179PubMedGoogle Scholar
  10. 10.
    Dranove D (1996) Economies of scale in non-revenue producing cost centers; implications for hospital mergers. J Health Econ 15:685–713CrossRefPubMedGoogle Scholar
  11. 11.
    Fordham R, Field DJ, Hodges S, Normand C, Mason E, Burton P, Yates J, Male S (1992) Cost of neonatal care across a regional health authority. J Public Health Med 14:127–130PubMedGoogle Scholar
  12. 12.
    Edbrooke D, Hibbert C, Ridley S, Long T, Dickie H (1999) The development of a method for comparative costing of individual intensive care units. The Intensive Care Working Group on Costing. Anaesthesia. 54:110–120Google Scholar
  13. 13.
    Dean JE, Edbrooke DL, Corcoran M (2002) The critical care national cost block programme: implementing a standard costing methodology on a national scale. Care of the Critically Ill 18 No.3, Stockton Press, UKGoogle Scholar
  14. 14.
    Jacobs P, Edbrooke DL, Hibbert CL, Fassbender K, Corcoran MC (2001) Descriptive patient data as an explanation for the variation in average daily costs in intensive care. Anaesthesia 56:643–647PubMedGoogle Scholar
  15. 15.
    Rapoport J, Teres D, Zhao Y, Lemeshow S (2003) Length of stay data as a guide to hospital economic performance for ICU patients. Med Care 41:386–397CrossRefPubMedGoogle Scholar
  16. 16.
    Reis Miranda D, Willams A, Loirat Ph (eds) (1990) Management of Intensive Care. Kluwer, AmsterdamGoogle Scholar
  17. 17.
    Jones J, Rowan K (1995) Is there a relationship between the volume of work carried out in intensive care and its outcomes? Int J Technol Assess Health Care 11(4):762–769PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Institute of Health EconomicsEdmontonCanada
  2. 2.Department of EconomicsMount Holyoke CollegeSouth HadleyUSA
  3. 3.Medical Economics and Research Centre, Sheffield (MERCS), Intensive Care Unit ‘R’ Floor Royal Hallamshire HospitalSheffieldUK

Personalised recommendations