Abstrakt
OBJECTIVES: In 2010, a network of cerebrovascular centers was established in the Czech Republic. Their integral parts are inpatient early rehabilitation units.
This rehabilitation is much more intense than in general rehabilitation wards, which makes it more expensive. The goal of the study was to calculate the costs of the early rehabilitation units after stroke, and initiate the change of (DRG based) reimbursement of this type of care.
METHODS: The sample consisted of 94 patients with stroke diagnosed after 01 April 2017 recruited in three hospitals (Prague-30, Ostrava-30, Ustı' nad Labem-34). There were 55 men and 39 women, the age ranged from31 to 95 years.
The costs were calculated by microcosting for each patient in the sample separately. Quantitative data (amounts, times) were recorded continuously into patient sheets.
The collected data were processed by statistical modules of MS Excel and R Commander. RESULTS: It was proved that the costs of rehabilitation treatment depend on the degree of disability of the patients.
The patients were categorized into 4 disability groups in agreement with the Czech Reimbursement Decree (Decree No. 134/1998 Coll. as amended). Then the costs ranged from CZK68,825 to CZK167,530 for the whole time of hospitalization, or fromCZK4,283 to CZK6,164 as a one-day average.
The main differences were in material costs and nursing costs. CONCLUSIONS: Cost and functional differences in early rehabilitation within a single diagnosis (stroke) were proved.
The project showed that the costs of treatment grow with the severity of the damage, while this relation is more obvious in the motor domain and less expressed (although also present) in the cognitive domain. The results were presented to the General Health Insurance Company to be used in the reimbursement revision.