Helge Garåsen The Trondheim Model - NSDM

6.4 Costs
6.4.1. Cost assessments
Estimating the costs of care is difficult. Registration of exact costs for each patient at a
general hospital or in community care is nearly impossible. Nurse and physician labour costs
are the main expenditures at both care levels, and there are no good methods of registration
that show how much time nurses and physicians use on each patient at general hospitals.
However, the nursing homes and home care services in the municipality of Trondheim have
reasonably precise reports on time used in the patient administrative system. The time that is
used on each individual patient varies greatly from visit to visit and from patient to patient
both in nursing homes and home care services (165). Also the use of medical procedures,
medication, X-ray, intensive ward, surgery, cytostatics vary extremely. Obviously, resource
utilization varies greatly and ought to be continuously registered for each patient in order to
get exact figures for the cost of care for each patient.
In the community of Trondheim each unit is a separate financial entity and during the last few
years accounts, with and without capital costs, have been established giving exact figures for
average costs per patients at every nursing home and every home-care unit. The intermediate
care department is also an independent financial unit and that has made it possible to calculate
average costs per patient and per day of care.
Calculating costs at the general hospital is more complicated. The most expensive treatments
at the general hospital are presumably surgery and intensive care. The cost analyses in study
II, in all likelihood, underestimate the costs at the general hospital as many of the patients (all
admissions were acute) in the trial required X-rays, intensive and coronary wards and several
surgical procedures, some on several occasions.
Only costs for community and general hospital care were used, as the trial was a comparison
between the cost effectiveness of public care models. This represents a weakness, as patients’
costs for transportation, medication, consultations by family physicians, physiotherapists, as
well as outpatient consultations for specialised examinations and private home care were not
monitored. Patient diaries, where information on all contacts and care given was continuously
recorded, could have been used to collect this information.
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