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Objectives The aim of the study was to investigate the causes and rates of readmissions within 90 days after primary and revision knee and hip arthroplasties. Patients and methods A total of 1,516 patients (290 males, 1,226 females; mean age 64.7±10.5 years; range, 21 to 91 years) who underwent primary total hip arthroplasty (THA), primary total knee arthroplasty (TKA), revision THA, and revision TKA between January 2013 and December 2014 were retrospectively analyzed. All readmissions within 90 days as of discharge dates of patients were analyzed and were categorized as planned readmissions related to the index admission, unplanned readmissions related to the index admission, planned readmissions unrelated to the index admission and unplanned readmissions unrelated to the index admission. Results Readmission rate in the overall of study group was found to be 5.61%. This rate varied depending on the procedure applied, ranging between 2.35 and 6.74%. Unplanned readmissions related to the index admission within 90 days consisted of 60.0% of total readmissions. A total of 82.0% of readmissions within 90 days was due to surgical reasons. Planned readmissions unrelated to the index admission within 90 days were also frequently seen (31.76%). Totally 48.23% of total readmissions within 90 days occurred within the first 30 days. A total of 48.23% of the total readmissions and 58.82% of the readmissions which were unplanned and related to the index admission occurred within the first 30 days. Conclusion After knee and hip arthroplasties, readmissions occur due to various reasons. Therefore, it is of utmost importance to identify the readmission type in the evaluation of readmissions which may increase the effectiveness of precautions to be taken.

Objectives:The aim of this study is to calculate case mix index values obtained for hospitals affiliated to Ministry of Health in context of the Diagnosis Related Groups data for the year of 2015, to determine the amounts which has to be received from global budget by calculating outpatient and inpatient incomes with respect to outpatient data and relative value produced by these hospitals, and to compare with the amounts received from the global budget in 2015.Materials and Methods:This study is a retrospective study of descriptive type. In the study, 665 hospitals affiliated with the Ministry of Health data of 2015 diagnosis related groups, global budget amounts, and outpatient data were analyzed in the Excel program to calculate the hospital case mix index values and the amounts received from the global budget according to the relative values they produced and medical examination numbers of the hospitals.Results:Mean case mix index of these 665 hospitals included in the study was calculated as 0.97. According to the service roles of the hospitals, the mean case mix index values were found to vary between 0.72 and 1.22. It was determined that 274 (41.2%) out of 665 hospitals analyzed in this study actually needed to receive more amounts, while 387 (58.2%) out of 665 hospitals needed to receive less amounts when compared to the amounts they have received from the global budget in 2015. As it was impossible to determine the exact amounts received by 4 (0.6%) hospitals from the global budget in the study, they could not be compared with the amounts obtained at the end of the calculation.Conclusion:In the study, it was determined that the A1 and A1 branch hospitals’ mean case mix index values were above 1, and that all hospitals in the E1 service role were needed to receive less amount than the global budget. It is proposed that the Ministry of Health’s global budget should be distributed to hospitals based on the Diagnosis Related Groups, and the global budget should cover all public and private health institutions.

Objective: This study aimed to compare the open and arthroscopic rotator cuff tear treatment methods in terms of cost-effectiveness. Patients and Methods: TThis study includes a prospective method of a total of 104 patients, 52 with open surgery and 52 with arthroscopic surgery, in the treatment of rotator cuff tears. Cost calculations of the treatment methods were obtained from patient invoices. Oxford Shoulder Score and Short Form-36 Health Survey Questionnaire were used for effectiveness calculations. The costeffectiveness comparison was conducted using the Incremental Cost Effectiveness Ratio (ICER) assessment. The difference between costs of open and arthroscopic surgery was analyzed using the SPSS 23.0 package program. with Mann-Whitney U test. Results: The average cost per patient was 4,838.7 Turkish Liras (TL) (866.22 USD) in open surgery and 5,770.33 TL (1,033.00 USD) according to the exchange rate at the time of writing, in arthroscopic surgery. Oxford Shoulder Score was 21.15 in open surgery and 20.83 in arthroscopic surgery. Short Form-36 Health Survey Questionnaire score was 61.92 in open surgery and 63.17 in arthroscopic surgery. The ICER calculated according to the Oxford Shoulder Score was – 2,912.37 TL (521,37 USD), while the ICER calculated according to the General Health Perception sub-scale of Short Form-36 was 745.57 TL (133,47 USD). In addition, statistical significant difference was found between the surgery, medication, medical and surgical materials, hospitalization and average cost of those treated with open surgery and those treated with arthroscopic surgery (p

Aim:The sector of medical device, has an important place in the diagnosis and treatment of the illnesses. Medical devices have been used in the prevention, diagnosis, follow-up or treatment of illnesses. The aim of this study is the comparison of the quantity of medical devices according to the Classification of the Regional Units (İstatistiki Bölge Birimleri Sınıflandırması [İBBS]) in Turkey and their usage proportions and also the comparison of Turkey with other OECD countries from the point of the quantity medical devices and finally, the factors that affect the quantity medical devices.Material and Method:The quantity of medical devices according to the Classification of the Regional Units, “Health Statistical Yearbook 2013”; the quantity of medical devices in OECD countries according to the OECD Health Data 2013; health indicators such as health expenditures per capita, life expectancy at birth, the proportion of the total health expenditures to the public expenditures were obtained from the data of the World Bank.Findings:During the assessment of the medical devices in Turkey, the medical device with the highest quantity is 'ultrasound device’ and the least one is MR device is seen. On the basis of the sector, the highest quantities of medical devices are in the hospitals affiliated to the Ministry of Health and the least ones are in the university hospitals. During the assessment of the usage of the medical devices, the highest usage proportion is in university hospitals as institutions, and in MR device is seen. According to the Classification of the Regional Units the least quantities of the medical devices were in the Southeast and Northeast Regions of Turkey. When it is compared with the other OECD countries, the quantities of the medical devices are less than ones in many OECD countries.Result:The quantity medical devices and their usage for countries were affected by several factors such as health systems of the countries, the pattern of the illnesses, GDP per capita, health expenditures per capita, life expectancy at birth, applied health policy, chosen drawback systems, the proportion of elderly population, and the proportion of the total health expenditures to the public expenditures. Therefore the assessment of the quantity medical devices and their usages, should take into account the countries’ economic, social and health indicators and cultural features.

Background There is only limited information about the cost-effectiveness of drug-eluting stents compared with bare-metal stents in Turkey. Aims To evaluate bare-metal and drug-eluting stents used in the treatment of coronary artery disease from the perspective of the reimbursement institution with cost-effectiveness analysis. Study design Retrospective cost-effectiveness analysis. Methods In our study, 329 patients diagnosed with coronary artery disease and treated with bare-metal or drug-eluting stents in the cardiology clinics of a public university hospital between January 1 and December 31, 2016 were investigated. Bare-metal and drug-eluting stents used in the treatment of coronary artery disease were evaluated retrospectively with cost-effectiveness analysis from the perspective of the reimbursement institution. Results The cost of treatment with a bare-metal stent was 2,131.41 Turkish Liras, and the cost of treatment with a drug-eluting stent was 3,546.14 Turkish Liras; the Quality Adjusted Life Years value of treatment with a bare-metal stent was 0.8371, and the Quality Adjusted Life Years value of treatment with a drug-eluting stent was 0.8924. All these data were analyzed by decision tree. As a result of decision tree analysis, the weighted cost of treatment with a bare-metal stent was 2,340.71 Turkish Liras and weighted Quality Adjusted Life Years value was 0.8332; and the weighted cost of treatment with drug-eluting stent was 3,970.90 Turkish Liras and the weighted Quality Adjusted Life Years value of the treatment with drug-eluting stent was 0.8911. With these values, the additional cost-effectiveness ratio was calculated as 28,179.12 Turkish Liras per acquired Quality Adjusted Life Years. The additional cost-effectiveness ratio is in the first zone in the cost-effectiveness plane and below the very threshold of cost-effectiveness. Conclusion In our study, it was concluded that drug-eluting stents are cost effective compared with bare-metal stents in the treatment of coronary artery disease. Considering the cost and effectiveness of the drug-eluting stent, it is thought that increasing reimbursement for this technology by the reimbursement agency would be beneficial for the service provider.

Background Central line–associated bloodstream infections (CLABSIs) are among the most frequent health care–associated infections. Central line bundle (CLB) programs are useful for reducing CLABSIs. Methods A retrospective study was designed to compare 2 periods: the prebundle and bundle periods. We evaluated the impact of a CLB including implementation of split-septum (SS) devices and single-use prefilled flushing (SUF) devices in critically ill children. Results During the prebundle period, the overall rate was 24.5 CLABSIs per 1,000 central line (CL) days, whereas after the initiation of the CLB, the CLABSIs per 1,000 CL days dropped to 14.29. In the prebundle period, the daily cost per patient with CL and CLABSI were $232.13 and $254.83 consecutively. In the bundle period, the daily cost per patient with CL and CLABSI were $226.62 and $194.28 consecutively. Compared with the period with no CLB, the CLB period, which included SUF and SS devices, resulted in more costs saving by lowering the daily total costs of patients and indirectly lowering total drug costs by decreasing antibacterial and more significantly antifungal drugs. Conclusions CLB programs including SS and SUF devices were found to be effective in decreasing the CLABSI rate and decreasing the daily hospital costs and antimicrobial drug expenditures in children.

The Analytic Hierarchy Method, is a method efficiently used in multi criteria decision making prob-lems. By using this methodology, through appropriate computing of packaged software,qualitative judgements can be converted to an efficient decision system. These decisions are then used to set priorities. In this study, Analytic Hierarcy Method has been applied to the year of 2007 investment decisions of the Ministry of Health on medical equipments in Turkey. The findings obtained were compared to the decisions of the Ministry of Health and the findings were found to be different than the investment decisions of the Ministry of Health.

Objective:The purpose of this study was to determine the unit cost of the main production centers of Ankara University School of Medicine Hospitals in 2008.Material and Method:Expenses and costs of the Ibni Sina and Cebeci Hospitals were obtained from the Hospital Information System and Revolving Fund distributed to the main production centers by using a step- down allocation method with three steps. Unit costs were calculated in the third allocati-on using the number of outpatients, inpatients and inpatient day.Results:The total cost of Ibni Sina Hospital (a 931-bed facility) and Cebeci Hospital (a 1153-bed faci-lity) were calculated as 117.994.696,14 TL and 106.378.973,80 TL respectively. In Ibni Sina Hospital, the average unit costs of outpatient clinics are higher in the departments of internal medicine compared to the departments of surgery. In terms of inpatient days, the avarage unit costs of departments of surgery is higher than the departments of internal medicine. In Cebeci Hospital, it is determined that the avarage unit costs of outpatient clinics are higher in the departments of surgery compared to the departments of internal medicine whereas the reverse is true for inpatient clinics.Conclusion:Being aware of unit costs in a large-size hospital would improve strategic decision-ma-king process including effective financial management, healthcare service planning and human reso-urces management.

The purpose of this study was to compare three alternative surgical therapies for Benign prostatic hyperplasia (BPH) in terms of their cost and effectiveness in a general hospital setting in Turkey. BPH is an important potential burden on health care resources in developing countries like Turkey, not only because of the increasing incidence of the disease, but also because of the differences in cost and effectiveness that exist among the various available treatment technologies. In this study, three alternative surgical treatments for BPH, namely open prostatectomy, transurethral resection of the prostate (TURP), and laser prostatectomy were compared in terms of their cost and effectiveness. Effectiveness was measured through the use of the International Prostate Symptom Score (IPSS) before the operation and at 3 months after. Laser prostatectomy was found to be the most costly and least effective way of treating BPH. This conclusion was valid both in terms of cost per prostate symptom score and cost per improvement of quality of life index. This study shows how a rough estimate can be made of the potential burdens that alternative treatment methods would impose on a country's health budget.