Is it Possible to Reduce Costs while Improving Quality in Health?

Abstract

Background: All over the world, how health services can be provided in better quality and more economical way has been continuously investigated. In this regard, the implementation of rapid recovery procedures called ERAS (Enhanced Recovery After Surgery) is becoming more widespread recently. In this study, we aimed to investigate the effect of the ERAS protocol on reducing health expenditures.

Materials and methods: Patients who underwent elective colorectal surgery in a public hospital between 2008 and 2018 were retrospectively reviewed following the approval of the Ethics Committee. The patients were divided into two groups as those who were applied ERAS protocol and treated with traditional methods. Patient billing information was requested from hospital management for analysis of treatment costs.

Results: It was observed that invoices of all patients were arranged according to the common price tariff (Healthcare Implementation Communique (HIC)) which public institutions are subject to. There was no difference between the ERAS group and the control group in terms of demographic characteristics, smoking and alcohol use history, body mass index (BMI) and ASA (American Society of Anesthesiologists) score. All costs examined were statistically lower in the ERAS group (p < 0.001). Duration of hospitalization, time to return to daily activities, readmission rates within 30 days after discharge, rate of complication and mortality were similar in both groups. In the postoperative period, the rate of admission to the ICU (Intensive Care Unit) was considerably higher in the control group (p < 0.001).

Conclusion: The implementation of the ERAS protocol provided both clinically positive effects and significant cost savings. A large percentage of the cost savings was achieved by a decrease in the rate of ICU stay.