Open Access Highly Accessed Research article

Direct costs associated with the appropriateness of hospital stay in elderly population

Joaquín F Mould-Quevedo1, Carmen García-Peña2, Iris Contreras-Hernández3, Teresa Juárez-Cedillo2, Claudia Espinel-Bermúdez2, Gabriela Morales-Cisneros4 and Sergio Sánchez-García2*

Author Affiliations

1 Departamento de Negocios Internacionales, Instituto Tecnológico y de Estudios Superiores de Monterrey, México, D.F., México

2 Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México

3 Unidad de Investigación en Economía de la Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México

4 Subdirección de Información de Recursos Humanos y Materiales, Dirección General de Información en Salud, Secretaria de Salud, México, D.F., México

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BMC Health Services Research 2009, 9:151  doi:10.1186/1472-6963-9-151

Published: 22 August 2009



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.


Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City.


The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9–5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6 – 2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The 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 inappropriate 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. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.