Analysis of HHC costs

Reducing costs by avoiding admission to hospital and decreasing hospital length of stay are often presented as central goals of HHC. Different researchers have thus been interested in the economical evaluation of HHC. Three topics have been studied namely: the analysis of the types of costs involved in the HHC practice, the comparison between the HHC costs and the traditional hospitalization costs and the analysis of the economic factors of both types of hospitalization.

First, different researchers have distinguished between the different types of costs involved in the HHC practice. [Jones et al., 1999] have identified five types of HHC costs namely: staffing costs, consumable costs, equipment costs, overhead costs (e.g. administration, car leasing, travel costs, etc.) and capital costs. [Aligon et al., 2003] have also distinguished between the direct medical care costs and the costs of medico-social coordination and administrative functioning. Another typology of HHC costs has been proposed by [Vergnenègre et al., 2006] who have identified four types of costs: staffing (nurses, doctors, etc.), coordination, consumable and travel costs.

In what follows, we are interested in the direct medical costs. Indeed, these latter are composed of the nurses and auxiliary nurses’ salaries (39% of the direct medical costs), pharmacy (21%), medical material (18%), etc. Figure 2-5 illustrates the distribution of the direct medical costs.

Second, several comparisons between HHC and traditional hospitalization costs have been developed in the literature. Indeed, the first comparison has been developed by [Jones et al., 1999] who have concluded that the HHC structure can deliver care with similar or lower costs than the traditional hospitalization for an equivalent admission. [O’Brien and Nelson, 2002] have also conducted a comparison between the traditional hospitalization costs and the HHC costs for elderly people who need acute care. The conclusion is that the HHC is less expensive than the traditional hospitalization as it allows the saving of 30 billion dollars per year. After that, [Aligon et al., 2003] have compared the average costs of nursing care within the HHC context and the traditional hospitalization context between 2005 and 2007. The results of this study clearly prove that the HHC is less expensive than traditional hospitalization. Another economic analysis has been developed by [Vergnenègre et al., 2006] in which the authors have compared the costs of the chemotherapy delivered to patients suffering from bronchi- pulmonary cancers at home and in hospital. The results of this study prove that the HHC allows the saving of 16.15% of the chemotherapy costs per treatment’s cycle compared to the traditional hospitalization.

The papers presented above have conducted to the same conclusion: HHC is less costly than the traditional hospitalization. However, other studies have proved the opposite. The results of the study developed by [Wilson et al., 1999] who have concentrated their work on the patients suffering from heart failure prove that the HHC for this type of patients is more expensive than the traditional hospitalization as the weekly costs increase on average by 1.382 dollars per patient. This conclusion can be explained by the critical clinical conditions of the patients involved in this study and the inconsistency of the quality of care delivered to the patients (this study involves 18 different HHC structures).

Third, the economic factors that considerably increase costs must be analyzed in order to compare the costs of both types of hospitalization as pertinently as possible. [O’Brien and Neslon, 2002] have enumerated these factors. On one hand, the four factors that explain the increase of the traditional hospitalization’s costs have been presented: medical errors (annual additional costs of 200 billion dollars), hospital acquired infections (the annual costs related to the infections are estimated to 4 billion dollars), decline of patients’ autonomy (the hospital stay of 75% of the patients aged of more than 75 years old is extended by 12.3 days that corresponds to 4.233 dollars per patient and per day) and death rate. On the other hand, the authors have explained that HHC costs can increase due to the risks that patients make errors for taking the corresponding drugs, for using a medical equipment, etc. during the absence of

home fitting; home support; transportation services; acquisition of non-medical equipment such as special chairs, ramps into the house, adapted toilets, showers, baths, special beds, etc. [Tarricone and Tsouro, 2008], [Aligon et al., 2002]. According to the circular of the 29th October 1974, even if the care delivery within the HHC context may be more expensive than the traditional hospitalization, the stay of the patient at home and the participation of the family to the care allow the reduction of the total HHC costs due to the fact that a part of the costs is shifted to the patients and their families. More precisely, [Jones et al., 1999] have affirmed that 44% of the patients use more lighting, 30% more laundry, 27% more heating, 17% more hot water and this generates more expenditures for the patients and their families. Moreover, if the care delivered by the family’s members are achieved by formal care givers, the annual costs of HHC would increase from 45 billion dollars to 75 billion dollars.

Note that different authors have mentioned that the results of the HHC economic analysis may vary according to different criteria related to the clinical conditions of the patient (the duration of stay, the nature of the main care protocol, the age and the dependency of the patient, the mode of exit from the HHC structure) and the type of HHC structure (its status, its size, the national setting within which the HHC structure operates) [Com-Ruelle et al., 2003], [Armstrong et al., 2008]