High cost patients for cardiac surgery and hospital quality in Turkey

ObjectiveEncourage quality improvements and assess high expenditures for patients with coronary artery bypass graft (CABG) surgery and hospital quality in Turkey.MethodsUsing the Turkish National Health Insurance Database (2009–2011), CABG surgery patients were identified using International Classification of Diseases Tenth Revision Clinical Modification codes. High-cost cardiac surgery patients had annual healthcare costs in the top 20% post-surgery. The empirical Bayes approach was used to combine mortality rates with hospital volume for quality index, weighing observed mortality according to estimation reliability, with the remaining weight placed on hospital volume. The relationship between hospital quality and high-cost payments was assessed using chi-square tests.ResultsTotal annual healthcare payments for 20,126 identified CABG patients were approximately €70 million. High-cost patients incurred 31% of the total expenditures. Although disease severity did not differ for patients across hospitals, those in the lowest quartile, in terms of quality, cared for 25% of high-costs surgery patients, compared with only 18% in the highest quality hospitals (p < 0.0001). €4 M in associated cost savings was calculated for patients shifting from low- to high-quality hospitals.ConclusionsResults imply that hospital quality improvements can reduce costs and improve morbidity and mortality rates in Turkey.