Economic comparison between Hospital at Home and traditional hospitalization using a simulation‐based approach

Hospital at Home (HAH) is a concept slowly expanding over time. At first this type of organization was used to accomplish low‐technical tasks. The main objective was to increase bed availability in hospitals for new patients. Nowadays, HAH structures are able to undertake more technical complex care such as (but not limited to) end‐of‐life care, chemotherapy and rehabilitation. The purpose of this paper is to propose a new methodology to make an unbiased economic comparison between HAH structures and traditional hospitalization.

This article accomplishes two main objectives: in the first part the authors propose a comprehensive literature review dealing with the comparison between traditional hospital and home care structures from an economic standpoint, showing that results are highly dependent on initial conditions of the study (patient health state, territory settings, bio‐medical parameters); in the second part the authors propose an unbiased economic comparison approach between health care provided in traditional hospital and home care network using formal modelling with Petri nets and discrete event simulation. As an example for the comparison a multi‐session treatment is proposed. Various scenarios are tested to ensure that results will be maintained even if initial conditions change. Relevant performance indicators used for comparison are economic costs from the point of view of the insurance and economic costs related to the consumption of resources.

It is found that HAHS can be used to control and improve patients flow on hospitals. Decisions about offering a multi‐session treatments at home must be taken, not only because of economic impacts on hospitals, but also because it follows strategic goals of the organization. This decision must be issued following a strategic analysis. Some important questions are: How should newly available beds be used in the hospital? Which territories will be covered? What is the best logistic strategy for delivering the medicines?

Comparing HAH with traditional hospitalization can provide useful information to healthcare authorities when deciding to create, or not, new HAH structures.