ABSTRACT
The authors examined the issue of learning by doing in terms of both the cost and outcome of treating coronary artery disease at one hospital between 1977 and 1981. Over time, the quality of outcome improved for both medical and surgical patients. During this time of cost-plus reimbursement, there was less conclusive evidence of concurrent technical efficiency gains. These findings are consistent with the hypothesis that the benefits of experience can be substantial but they do not just happen: they require proper provider motivation.
Subject(s)
Coronary Disease/therapy , Outcome and Process Assessment, Health Care , Boston , Coronary Artery Bypass/economics , Coronary Disease/economics , Cost-Benefit Analysis , Female , Hospitalization , Humans , Longitudinal Studies , Male , Middle Aged , Technology Assessment, BiomedicalABSTRACT
For patients who underwent cardiac catheterization for stable angina pectoris at the authors' hospital, initial treatment charges including the cardiac catheterization were approximately $28,000 for coronary surgery and $6,000 for medical therapy. Even after controlling for disease severity and after including medical patients who crossed over to surgery, the slightly increased 3-year follow-up costs of medical therapy offset only approximately 11% of the far higher initial costs of surgery. Surgical patients were more likely to have sustained, substantial symptomatic improvement at 3 years (68% vs. 53%, P less than 0.05) but were no more likely to have, maintain, or regain a job. Although the cost-effectiveness of coronary surgery may compare favorably with other modern therapies for other conditions, coronary surgery did not pay for itself at 3-year follow-up in our patients.
