The Importance Of Perspective

Any discussion of financial implications of laparoscopy must be examined from the perspective of the payer. However, in the U.S. health-care system, there are three "payer" perspectives: that of society, the hospital, and the patient. The perspective of the patient is the most difficult and subjective to evaluate as it depends on the patient's individual insurance, deductible level, and employment status.

The hospital's perspective usually includes most of the direct costs and is easier to measure. Furthermore, the patient perspective cost is directly related to this as the hospital cost is eventually charged to the patient. The hospital costs include the resources required to perform a procedure and immediate postoperative care. These, in addition to physician fees, represent the majority of costs from surgical procedures that do not include long-term postoperative care. Importantly, one should note that within each hospital system, the budget is divided into different departments. Savings garnered by decreased length of stay may decrease overall hospital cost, but may increase operating room supply costs (e.g., laparoscopy). Hospital administrations must, therefore, take a broader look at the financial implications of new technologies as they affect different cost centers in different ways.

The perspective of society involves both direct and indirect costs. As Medicare plays a large role in financing health care, a significant percentage of direct costs affect the overall national health-care budget. Society also is influenced by loss of productivity that results during the recovery phase of the postoperative period. These indirect costs can be difficult to measure, but can represent a significant loss of gross national

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