Cost Vs Charge

It is difficult to evaluate the cost-effectiveness of a technique without comparing similar units of measurement. Many published evaluations use charge figures provided by the hospital system (1). These numbers are typically easier to obtain than cost figures, but do not reflect the true resource allocation as they account for profit margins. Different services in a hospital have different cost-to-charge ratios. Furthermore, rates for items, such as room and board, typically are determined based on the need to pay for both utilities, such as electricity and water, as well as services such as nurses' salaries. Also, as third party payer reimbursement of charges varies, what a hospital health-care system charges for laparoscopic surgery, gets paid, and actual costs can be very different. As such, when evaluating health system costs of a procedure or technology across a spectrum of hospitals and payers, actual costs, and not charges, must be reported.

Nevertheless, cost analyses of laparoscopic surgery can still be ambiguous. One issue is difficulty with the accurate assessment of the cost of capital equipment. Such items as a robot, laparoscopic ultrasound, camera, and televisions are usually paid from operating room capital budgets and amortized over many years. Depreciation costs and usage per case can only then be estimated. Conversely, costs of disposable equipment can be established with more accuracy but are still influenced by the vendor contract, which varies based on the volume of purchase.

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