R. Harper*,  I Meredith, P L See, J Kealey and K Sampson.

Centre for Heart and Chest Research, Monash University and Monash Medical Centre, Vic.

CAS is a commonly performed procedure in Australia at considerably expense to the health budget.  In this prospective study of 186 consecutive patients (124 public, 62 private) we have compared the costs of elective CAS in public patients to the costs and charges of the same procedure in private patients in a co-located private hospital (CLPH) which utilizes the same cardiac catheterization laboratory.  Charges for a non co-located "industry standard private hospital" (ISPH) have been estimated from these figures.  For public patients Federal Government (Gvt) costs have been taken as equivalent to the casemix payment.  For private patients Gvt costs have been estimated by the addition of (1) 75%  of the scheduled professional fees (ii) the pharmaceutical costs and (iii) 30% of the private health insurance (PHI) costs since the Gvt now provides a 30% subside of PHI premiums.

Results:  Immediate outcomes were similar in both groups.  Private patients tended to have a longer hospital stay (1.7 vs 1.5 days) and a greater use of ABCIMAX (16% vs 8%) (P<0.05) but a similar number of stents per case (1.5 vs 1.5).  Salary costs, overheads and nonstent consumables were similar.  For private patients charges exceeded costs by a factor > 2.  Total costs and charges are shown in Table.

Conclusion:  Despite similar treatments and similar immediate outcomes CAS in private patients is more than twice as expensive as in public patients with Gvt costs similar for both.  As CAS is more frequently performed in private patients than in public patients encouraging more people to take out PHI will paradoxically increase costs to the Gvt and increase overall health expenditure.

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