Risk assessment and the cost of survival

The costs of caring for a critically ill patient will vary according to an individual's severity of illness. Where reimbursement is based on individual services provided, severity of illness is not an important financial consideration. Reimbursement as a global, per-case fee, as with Diagnostic Related Groups (DRG) in the United States, may not adequately recognize a hospital's cost differences between low and high risk patients. This article discusses how costs are categorized and relationships between a patient's presenting condition and expected costs. Severity-of-illness does not directly predict costs when all intensive care patients are included, but a relationship can sometimes be demonstrated within a disease category. The factors predicting costs may differ from those predicting survival. Cost savings from limiting intensive care are generally less than imagined, and limitations on intensive therapy should not be based exclusively on prognostic scoring systems.