The need for differential tariffs for cardiac surgery in Israel in the era of aging population and emerging technology

Background

Reimbursement for surgical procedures in Israel does not account for diversity in costs of various procedures. With new and more costly technology coupled with higher risk patients needing more complex surgery, these tariffs may not reflect the true financial burden on caregivers.

Objective

To determine the relative cost of heart surgery as function of predicted risk and complexity of surgery.

Methods

Four-thousand four-hundred and nine patients undergoing cardiac surgery were stratified according to (i) type of surgery and (ii) clinical profile (as represented by EuroSCORE). Approximate cost of each group was assessed by the average number of days in ICU and ward multiplied by the respective daily cost as determined by the Ministry of Health, plus the cost of fixed components used in the operating room (manpower and disposables). Cost was evaluated according to these variables. Cost variability was determined using ANOVA.

Results

Both increased value of EuroSCORE and type of surgery were directly correlated with cost (p<0.0001): up to 180% increase in cost between low and high risk patients in identical surgery and up to 77% increase with respect to type of surgery. There was up to 330% increase in cost between low risk and low fixed price surgery and high risk patients with high fixed price surgery.

Conclusions

Cost of heart surgery is directly influenced by patient profile as well as type of surgery. Modern day technology is more costly yet has become mandatory. Thus reimbursement for heart surgery should be based on differential criteria: clinical risk profile as well as type of surgery. Our data shows an urgent need for design and implementation of a realistic differential tariff model in the Israeli medical reimbursement system.