[Medical and economic evaluation of neonatal hospital at home structure]

Abstract

Background: Hospital at home (HAH) shortens hospitalization time by providing at-home hospital-level care. The aim of this study was to describe and assess the cost of the neonatal HAH stay and compare it to the incomes produced by activity-based payments during the 1st year of a neonatal HAH program.

Method: Medical and economic cost study from the hospital's point of view. For children admitted to the neonatal HAH unit between May 2010 and May 2011, sociodemographic characteristics were identified, consumed resources evaluated, and costs compared to the incomes produced by activity-based payments.

Results: Over 75% of children admitted to neonatal HAHs were former preterm infants and 67% of stays included nutritional support. The average length of stay was 16.5 days (SD, 11). The 85 stays produced 152,582 euros of income, the median income was 1531 euros. The median cost of the HAH stay was 1945 euros, resulting in a loss of 45,518 euros for the hospital, but the filling rate was not at its maximum during this period of scalability (77%). Personnel was the most costly item (73% of the total cost) followed by general management and structural costs (20%).

Conclusion: Economic aspects must be considered to preserve the financial viability of a HAH unit, but the secondary human benefits must be highlighted. A 100% occupation rate would nearly balance the neonatal HAH budget. However, fees must be adjusted to ensure the sustainability and development of these structures.