INTRODUCTION
Once an admirable model of universal healthcare, the Spanish public system suffered a severe financial downturn at the time of the last recession with repercussions at multiple levels. In addition to provision of basic health services, health outcomes of population were affected in a system already strained by many years of structural and financial debts and perpetually slanted toward acute inpatient care [1,2]. Yet public authorities did not take the opportunity to reorganize and improve public healthcare services and lessen the financial burden, with some notable exception. The realization that hospitalizations and hospital care were one leading cause of excessive healthcare expenses opened the way for a shift from traditional ‘bed-based’ inpatient care to hospital-based ambulatory and outpatient care services [3,4]. A systematic review recently published inJAMA Internal Medicine showed that alternative ambulatory approaches to inpatient care for patients with medical conditions were associated, as compared to traditional inpatient admission, with similar health outcomes and similar or higher patient-reported satisfaction levels but at significantly lower costs [5]. These alternative models for conditions conventionally designed to require hospitalization include, to mention a few, observation units, hospital-at-home, daycare hospitals, and quick diagnosis units. While the former were developed decades ago and extended to additional medical conditions in recent years, quick diagnosis units became a new paradigm of innovation in hospital ambulatory medicine in the 2000s [3-5]. By sidestepping unnecessary and expensive admissions for purely diagnostic purposes, today these units represent a well-established healthcare delivery model conceived to achieve quick diagnoses for patients complaining of potentially severe diseases, most notably cancer [5-8].
Although limited, available reported data suggest that the quick diagnosis unit approach may be cost-effective. Studies evaluating the cost outcomes of these units have been reported as non-comparative cost analyses of single units [9,10] or with the standpoint of comparing the costs of these patients with those of inpatients hospitalized for the same condition [11-13]. These investigations have been valuable for the objective assessment of the actual costs incurred by quick diagnosis units of single centers. However, how cost outcomes compare between units of different hospitals is unknown. Such cost-comparison evaluation could add a broader and useful perspective to the economic potential of these units within the new model of hospital ambulatory medicine and hospital-based care in general.
The objective of this study was to investigate the costs incurred by patients with potentially severe diseases managed at two quick diagnosis units of hospitals with different levels of complexity in Barcelona. A micro-costing analysis based on resource consumption data from the two centers was applied.