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COMPARATIVE STUDY
JOURNAL ARTICLE

Costs, charges and revenues of elective coronary angioplasty and stenting: the public versus the private system

R W Harper, K D Sampson, P L See, J L Kealey, I T Meredith
Medical Journal of Australia 2000 September 18, 173 (6): 296-300
11061398

OBJECTIVE: To calculate the costs of elective coronary angioplasty and stenting (CAS) in the public and private healthcare systems and to compare these costs with the charges levied and the revenues obtained.

DESIGN: A prospective health economics study.

SETTING: A tertiary care public hospital and a co-located tertiary care private hospital in the 12 months from February 1998.

STUDY POPULATION: 186 consecutive patients (124 public, 62 private) undergoing elective CAS.

MAIN OUTCOME MEASURES: Outcome of CAS; exact costs of CAS in the two hospitals; exact charges to private patients; estimated charges in a typical, not co-located, "industry standard private hospital"; estimated costs to the Federal Government of CAS in the public and private system.

RESULTS: The immediate and six-month outcomes in the two groups were similar. The average cost of CAS in public patients was $5,516, compared with $5,844 in private patients. The length of stay, number of stents per case and use of nonstent consumables was similar for both groups. Average charges for CAS in patients in the co-located private hospital were $13,347, and estimated average charges for CAS in an industry standard private hospital were $14,978. Estimated current costs to the government for CAS in a public hospital, a co-located private hospital, and an industry standard private hospital were $5664, $5,394 and $6,201, respectively.

CONCLUSIONS: Despite similar treatments and similar treatment costs, CAS in the private system, as a consequence of the charges levied, is more than twice as expensive as in the public system, with government costs similar for both systems. These data (together with data from other studies showing that CAS is performed more frequently in private patients) suggest that encouraging more people to take out private health insurance will, paradoxically, increase government costs for CAS as well as increasing overall health expenditure.

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