The role of changing clinical practices in the rising costs of hospital care.

To assess whether changes in clinical practice have contributed to rising hospital costs, we studied 2011 patients who were hospitalized at the University of California, San Francisco, in 1972, 1977, or 1982. For most of the 10 diagnoses studied, there was little change in total use of services by patients. In-hospital survival did not differ during the decade, and length of stay, numbers of special-care days, and use of laboratory services generally remained the same or declined. Only for patients with acute myocardial infarction did the use of imaging procedures increase substantially (e.g., cardiac catheterization was provided to 2 per cent of patients in 1977 and 40 per cent in 1982). Contrary to conventional wisdom, "little-ticket" procedures, such as laboratory tests, did not contribute to rising costs, and new imaging techniques were commonly substituted for older, more invasive procedures. The primary causes of rising costs were the provision of surgery to patients admitted for acute myocardial infarction, delivery, or respiratory distress syndrome of the newborn and the provision of other intensive treatments for the critically ill.