Keynote lecture: Costs of burns and plastic surgery: The UK experience
Abstract: The growing cost of healthcare is of concern to every society globally. Its importance has been brought into stark relief by the economic crisis seen in many parts of the world and Europe in particular. A great many pieces of work have looked at healthcare costs and claimed to represent the cost of therapeutic interventions but a review of the global literature on this subject has revealed systematic errors of methodology in the majority. A common feature in the literature is confusion between charges made by a hospital and the true cost of the care provided if calculated by other methodologies.
A long-term programme of work in England has been focused particularly on burns and plastic surgery in an attempt to establish the true cost of care provided on a patient by patient basis. The findings of this work have indicated that some of the conclusions commonly held are indeed correct: Staff time and input to a particular patient is the single largest cost driver to the cost of the care that patient receives by that a surprisingly small contribution to the overall cost is made by disposables, be they implants, injectables, dressing materials etc.
By understanding the details behind departmental income and by breaking down burns and plastic surgery workloads into different clinical silos it is possible to identify those areas of work which are profitable to a department and a hospital while identifying some surprisingly important areas of work make a loss but may be acting as effective loss leaders. It can be concluded that clinician perceptions of cost are frequently inaccurate.
It is hoped this work will form the basis of a more rational and accurate understanding of the costs of surgical care in burn and plastic surgery and might hopefully lead in certain health economies to a more rational and accurate approach to surgical care remuneration and even service organisation and capacity.