Reimbursement methods in health organizations, and determination of service costs for laparoscopic surgeries and comparison with communiqué on healthcare practices prices in bundled payment program

The main goal of healthcare organizations is to provide healthcare required by the society, at desired quality, time, and with minimum possible cost. The sustainability of healthcare organizations depend on the production of healthcare with minimum costs and maximum quantity, as well as the use of existing resources with maximum efficiency. Calculation of production costs of given healthcare services is important for both health organizations and reimbursement organizations that acquire the services. Healthcare costs represent one of the basic sources required for the production of healtcare services that are demanded by individuals. Countries or societies need to spend money to produce their basic need, health. To achieve sustainable compensation of expenses of health service organizations, it is particulary important to determine the sources and methods, which would be used to cover the finances. Reimbursement organizations varies according to healthcare systems of different countries. Health reimbursement, by definition, is reimbursement of the service fee of medical products/healthcare service, whole or in part, to the individual/patient or the organization providing the service/product. In Turkey, recent developments and innovations in healtcare policies have focused on changing the structure and modus operandi of the healthcare system. During this transformation process, one of the most problematic issues is providing sources. To meet the growing demand, health sector increases the level of resources. In addition, the majority of individual health expenses are provided by companies. To ease this complicated process, the diagnosis-based (bundled payment) program in healthcare has been implemented. Bundled payment (also known as package pricing) is defined as setting a single price for all operations for treatment and diagnosis of common diseases, which do not differ with respect to service content on patient basis, thus for which approximate costs can be estimated. The aim of the present study was to perform a cost analysis for laparoscopic cholecystectomy, the cost of which is reimbursed through implementation of package pricing. Cost analysis was performed to determine the revenues and expenditures of the hospital, and to determine whether the method of reimbursement covers the operating costs of the hospital. The study population consisted of 264 patients, who received laparoscopic cholecystectomy service from a Dokuz Eylül University Hospital in 2013. Invoices of all patients were examined, and 239 patients, who received only laparoscopic cholecystectomy, were included in the cost analysis. The results of cost analysis indicate that healthcare provider incur loss for the service provided, when costs of production and package fees provided by the state are compared. Keywords: Health costs; cost analysis; reimbursement methods in health; bundled payment method.