Costs of and Needs for Resources in Hospital Care: A Calculation Model and Applications in Some Typical Cases in Orthopaedic Surgery

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Abstract
It will be necessary in the future to calculate the cost of hospital care of patients subjected to specialist treatment (Alling et al. 1973). This would facilitate a fair distribution of the available resources over the specialties. Also, it would be easier to prove the alleged possibility of saving considerable community funds for instance in the prosthetic surgery of joints (Taylor 1976) if absolute cost figures were at hand. This paper presents a calculation model for estimating the working costs of in-patients requiring various amounts of care in orthopaedic surgery. The working costs of the Department of Orthopaedic Surgery at the University Hospital have been split into three grups: I) basic cost, 2) nursing cost proper, and 3) special costs. The basic cost has been calculated per pa-patient per day and has been subdivided into hotel expenses and doctors' salaries. The nursing cost proper covers mainly staff salaries and wages, which have been apportioned between three categories of patients with regard to the ward staff workloads arising. The categories have been established, following time and motion studies, to determine the work contribution in each case. The special costs refer to the costs of regular laboratory tests, special examinations, and operations. The latter cost group has been estimated from the consumption of materials and by time studies. The model as outlined has then been applied to three common categories of cases in orthopaedic surgery associated with a well-defined handicap and workload. The overall cost of these typical in-patient at the Department of Orthopaedic Surgery at Uppsala has been calculated. Following time and motion studies to chart the relationship between the workload categories, our model should be applicable in most hospitals and specialties. Knowledge of the costs is one necessary basic instrument in costbenefit analysis.

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