The Patient Cost Estimator—Informing Health Care Decision-Makers

The Patient Cost Estimator

The Patient Cost Estimator is an innovative, web-based tool that allows you to view estimated average hospital costs by clinical groups, know as Case Mix Groups (CMGs), at both provincial and national levels. Developed by the Canadian Institute for Health Information (CIHI), the tool allows hospital managers, policy-makers and researchers to access information quickly and easily in order to create more comprehensive financial forecasts.

For example, as the manager of a 200-bed New Brunswick community hospital who’s thinking of adding a joint replacement program, you will have many factors to consider: the costs of procedures, the number of procedures that will take place, the number of resources required to do them and funding.

While you might begin with an internal audit of your hospital’s existing volumes, internal costs, resources and overall structure, this can account only for the services that are already occurring in the hospital. You can use CIHI Portal to estimate the number of joint replacements done last year for patients from your catchment area; however, since you don’t have an existing joint replacement program, how do you determine the estimated cost for such a program?

Using the Patient Cost Estimator, hospital planners can fill in these knowledge gaps. You can view the average estimated cost of a unilateral hip replacement for a person age 18 to 59 ($10,459) compared with that of someone between age 60 and 79 ($9,790). Using the combination of the estimated frequency of that procedure in New Brunswick and the demographics in the area the hospital serves, the tool can help you develop an accurate, more informed budget. As well, you can find out the average acute length of stay for a hip replacement to further support your resource planning.

The tool presents the estimated average cost of services, average acute length of stay and patient volumes per CMG by jurisdiction and age group. It also produces summary reports, which display the most common CMGs by jurisdiction and age group, as well as reports displaying the CMGs incurring the highest and lowest in-hospital estimated average costs by jurisdiction and age group. This type of information may also be of interest at a ministerial level to better understand the costs associated with certain patient groups.

The Patient Cost Estimator facilitates access to this crucial decision-making information. Having these estimates in an easy-to-use, accessible format means that those who need this information most, including hospital managers, health planners and researchers, can use jurisdictional information to make more accurate financial estimates. It also presents an opportunity for the public to gain a better understanding of hospital costs, where a significant portion of costs is incurred by our health system.