The effect of payment and working system of specialist surgeons on the rate of negative appendectomy in different types of hospitals in Turkey

Abstract

Aim. The negative outcome following appendectomy in those with presumptive diagnosis of acute appendicitis varies from 10-20%. We aimed to evaluate the rate of negative appendectomies and to investigate whether the fee-for-service policy and working system of hospitals for doctors increases the rate of negative appendectomies or not. Methods. The number of appendectomies with the presumptive diagnosis of acute appendicitis in Turkey is 85350 in 2010; 3437 patients selected by simple random sampling from randomly selected 42 hospitals. The effect of payment system and working system of state, private and university hospitals for doctors on the rate of negative appendectomies were evaluated. Fee for service payment system is valid in the state and private hospitals. Specialist surgeons are on duty for 24 hours in state hospitals. Results. The negative appendectomy rate was 13.5% in state hospitals, 18.5% in university hospitals and 20.8% in private hospitals. The rate of negative appendectomy in state hospitals in which surgeons were on duty for 24 hours was significantly lower than the university and private hospitals in which surgeons were on call (p<0.001) Fee for service had no direct effect on the rate of negative appendectomy, since this rate was higher in private hospitals, and lowest in the state hospitals. Conclusion. The negative appendectomy rate was significantly lower in state hospitals where the specialist surgeons were on duty for 24 hours. The data obtained is contradictory to the common belief that payment policy increases the negative appendectomy rates