Break up the charges of ICU

This is the 4031 article

of Diagnostics

Sometimes in the emergency room, some patients with serious illness are encountered, and it is recommended to be admitted to the ICU. Family members will hesitate, saying that the cost of ICU is very expensive, tens of thousands or even tens of thousands a day, and they are afraid that they cannot afford it. In fact, not only the patient’s family members have this concern, but also some medical staff in other specialties.

Is it true? It’s also right or wrong. It is true that some patients spend tens of thousands of yuan a day, but it is not uncommon for them to spend only a thousand yuan a day, or even a few hundred yuan. Today I will tell you where all the money is spent. The first thing to note is that the ICU charges are different between provinces in China, and the relevant departments of the local government formulate the charging standards. What is more interesting is that although Shanghai is an international metropolis with high living costs, the ICU charges are even lower than many economically underdeveloped provinces. The government’s efforts to strictly control medical expenses can also be seen in the ICU charges.

I often say that ICU charges are only 360 yuan more expensive than regular wards. Why do you say this way? Patients admitted to the ICU are charged 360 yuan per day, which is not available in ordinary wards. It includes the ICU guardianship fee, nursing fee, bed fee, and rescue fee, all of which are included in this 360 yuan. We know that ICU patients often need to use a variety of monitoring equipment, except for the 360 ​​yuan, which cannot be charged separately; ICU patients are often super or first-level nursing care, and the nursing fee cannot be charged separately; the bed fee is also included; If a patient wants to be rescued, he can’t charge an additional rescue fee; ICU patients often use various microinjection pumps, and sometimes a severe patient even needs to use more than a dozen, and no additional charge can be made. Assuming that the patient lives in a general ward, although there is no charge of 360 yuan, the nursing fee and the bed fee are charged separately for each tens of yuan. If monitoring equipment and micro-pumps are used, they should be charged separately according to the actual usage. If you do this, don’t you think the ICU’s 360 yuan is too high?

In addition, other expenses for ICU patients are charged as much as they actually use, and the billing standard is exactly the same as that of ordinary wards. The high charges for ICU patients are not because they live in the ICU, but because the patient is seriously ill and requires more expensive drugs or equipment. Assuming that these treatments can also be done in ordinary wards, the cost of patients living in the ICU and in the ordinary ward should be about the same. Of course, this is only an assumption. Many treatment measures are too complicated and require perfect monitoring and a lot of medical and nursing power, which is very difficult to do in ordinary wards. So going back to the previous article, when a patient is seriously ill and needs to be admitted to the ICU, it is wrong to think that the ICU will add a lot of extra costs. The cost depends on the treatment the patient needs, not which ward they live in.

Generally speaking, the expenses of ICU patients are mainly spent on tests, medicines, consumables, treatment, etc. Inspection fees are often large, which many people may not have thought of. The condition of ICU patients changes rapidly, and the treatment plan needs to be adjusted in a timely and frequent manner. Therefore, many examinations are repeated almost every day, which is not the same as that of a general ward. The condition of ordinary patients is relatively stable, and it is often enough to re-examine once a few days. Although it seems that the fees for each test are mostly tens of yuan, the number of inspections is large and frequent, and the accumulation often accounts for a large part of the total treatment cost.

Some complex diseases may require more expensive drugs, such as patients with severe infections, and sometimes antibiotics may cost thousands of dollars per day. Some patients require transfusion of blood products, such as coagulation factors, albumin, platelets, blood, etc., and the cost of these is relatively high. Furthermore, critically ill patients often need to use a variety of medical equipment, such as ventilators, bedside blood purification equipment, etc. The use of these equipment is usually calculated by the hour, plus the required consumables, etc. possible.

Sometimes we hear that a certain patient spends tens of thousands of yuan a day in the ICU. This situation is rather special and not universal. Often, the patient may have undergone surgery on the same day, which includes the surgical fee and surgical consumables, not all the money spent by the ICU. There is also the possibility of using a lot of expensive blood products when rescuing patients. Even so, it is often a day or a few days that the cost is relatively high, and it is rare to spend tens of thousands of yuan per day on average.

It should be noted that most of these expenses are covered by medical insurance, and 80%-90% are borne by medical insurance. Most of the patients who are admitted to the ICU do not have to pay high expenses themselves, usually a few thousand yuan is enough, which may not be the same as everyone’s imagination. What everyone sees in the news is often especially critical and expensive patients. Ordinary ICU patients have little news value and are generally not reported. So give everyone an impression that the cost of living in ICU is highIt’s scary, it’s not.

Author: Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Emergency and critical care unit

Wang Xuemin