Gereksiz Sağlık Harcamaları: Kolesistektomi İşleminde Tekrarlayan Tanı Testlerinin Değerlendirilmesi.

Abstract

Aslan, H., “Unnecessary Health Expenditures: Evaluation of Recurrent Diagnostic Tests in Cholecystectomy” Hacettepe University Graduate School of Social Sciences Healthcare Management, Ph. D. Dissertation, Ankara, 2019. This study has two main purposes. The primary purpose of this study is to calculate the numbers and cost rates of unnessarily replied five liver function tests and three abdominal ultrasound tests which are the most frequently used health technologies on cholecystectomy patients and the second purpose is to calculate the share of redundant duplicated test costs in total test expenditures and total patient expenditures. The research includes all patients who underwent cholecystectomy in ANEAH in 2016 and alkaline phosphatase (ALP), alanine aminotransferase (ALT), spartate transaminase (AST), gamma glutamyl transferase (GGT), Bilirubin (Total, direct) tests which are the diagnostic tests used in order to perform cholecystectomy procedure in these patients and ultrasound. All records of the patients in the ANEAH were examined in totally one hundred eighty days, including ninety days before and ninety days after cholecystectomy. A test requirement schema was prepared according to ASA scores by taking the information in literature and expert opinions. Test records for each patients were determined as pre-procedure and post-procedure according to this schedule. Current Health Implementation Notification prices dated from 18th June, 2016 were used in the calculation of the test costs and other expenditures related to the patients. Number and cost rates of unnecessarily replied tests and their shares in total test and patient expenditures were calculated in the study. Whether replied test costs vary or not according to gender, surgery technique, age and ASA scores were analyzed. At the end of the study, it was found that approximately 80% of laboratory diagnostic tests and approximately 20% of ultrasound tests were unnecessarily replied. Unnecessarily replied test costs account for 8,48% of total test expenditures and 0,93% of total patient costs. It was determined that unnecessarily replied tests varied according to gender, surgery technique, age and ASA scores. Providing feedback to physicians about unnecessarily replied test rates, organizing training on tests and costs and trainings for medical and legal concerns, providing ease of use and easy access to test results of physicians on computer programs and putting warning and information screens in test request modules of the used computer programme and preventing to create test order panels on these programmes are thought to be the recommendations for reducing the unnecessarily replied test rates.