Direct Costs Associated
with the Appropriateness
of Hospital Stay in Elderly
Joaquín F. Mould-Quevedo, Carmen García-Peña,
Iris Contreras-Hernández, Teresa Juárez-Cedillo,
Claudia Espinel-Bermúdez, Gabriela Morales-Cisneros
and Sergio Sánchez-García
Ageing of Mexican population implies greater demand of hospital services.
Nevertheless, the available resources are used inadequately. In this study, the
direct medical costs associated with the appropriateness of elderly populations
hospital stay are estimated.
14 Social Work in Public Health and Hospitals
Appropriateness of hospital stay was evaluated with the Appropriateness Eval-
uation Protocol (AEP). Direct medical costs associated with hospital stay un-
der the third-party payer’s institutional perspective were estimated, using as
information source the clinical les of 60 years of age and older patients, hos-
pitalized during year 2004 in a Regional Hospital from the Mexican Social
Security Institute (IMSS), in Mexico City.
e sample consisted of 724 clinical les, with a mean of 5.3 days (95% CI
= 4.9–5.8) of hospital stay, of which 12.4% (n = 90) were classied with
at least one inappropriate patient day, with a mean of 2.2 days (95% CI =
1.6 – 2.7). e main cause of inappropriateness days was the inexistence of
a diagnostic and/or treatment plan, 98.9% (n = 89). e mean cost for an
appropriate hospitalization per patient resulted in US$1,497.2 (95% CI =
US$323.2 – US$4,931.4), while the corresponding mean cost for an inap-
propriate hospitalization per patient resulted in US$2,323.3 (95% CI =
US$471.7 – US$6,198.3), (p < 0.001).
Elderly patients who were inappropriately hospitalized had a higher rate of
inappropriate patient days. e average of inappropriate patient days cost is
considerably higher than appropriate days. In this study, inappropriate hospi-
tal-stay causes could be attributable to physicians and current organization-
Ageing of the Mexican population is one of the higher impact phenomena which
began manifesting during the XX Century, and which will undoubtedly be an
essential element in the creation of the history of Mexico in the XXI Century.
Life expectancy of Mexicans doubled during the second half of the last century,
raising from 36 years in 1950 to 74 years in year 2000, and it is expected to reach
80 years in 2050 .
Ageing of the population will imply a greater demand of health services, as a
consequence of the high rates associated morbidity. Among the diseases of the el-
derly population are chronic-degenerative conditions, that make them fragile and
turns them into a population that utilize many health services. However, it is well
known that part of the hospital resources are used inadequately, either because
the patients receive assistance that does not turn into health benets or because