Elements of Cost-Effective Nonemergency Surgical Care

Abstract

September 2007

Section Elements of Contemporary Practice

7 Elements of Cost-Effective Nonemergency Surgical Care

Robert S. Rhodes, M.D., F.A.C.S.
Adjunct Professor of Surgery, University of Pennsylvania School of Medicine, and Associate Executive Director and Director of Evaluation, American Board of Surgery

Charles L. Rice, M.D., F.A.C.S.
Professor, Departments of Surgery and Physiology and Biophysics, and Vice Chancellor for Health Affairs, University of Illinois at Chicago Medical Center

This chapter offers an overview of basic principles of cost-effectiveness and quality assessment. Surgery is particularly suitable for cost-effectiveness analysis because surgical illnesses are usually of relatively short duration, surgical outcomes are readily quantified, and surgical costs often involve global fees. The authors define cost-effectiveness as cost divided by net benefit, with the numerator (cost) expressed in dollars and the denominator (net benefit) expressed as beneficial outcomes minus adverse outcomes. Since cost-effectiveness is integrally related to quality of care issues, recent changes in the concepts of quality are addressed, and skills needed to apply the new concept of quality (e.g., literature analysis, technology assessment, efficient use of diagnostic tests, decision analysis) are examined. Systems of care (as reflected in critical pathways, coordination of care, and disease management) are discussed. Analysis of cost-effectiveness is described; the implications of outcome variations are explored; and the relation of volume to outcome is explained. Practical issues in improving cost-effectiveness are addressed, and ethical and legal concerns are considered. This chapter contains 5 figures, 2 tables, and 204 references.

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