The mortality rate from hip fractures has dropped by 30 percent within a year, thanks to new Health Ministry guidelines that encourage the performance of hip-joint replacement surgery within 48 hours of the fracture.
The improvement comes as a result of a study conducted by the ministry's medical administration, which found that conducting hip surgery within two days of injury drastically reduced the death rate from these operations.
Following the study, administration director Dr. Michael Dor and former administration director (and now Wolfson Medical Center director-general) Dr. Yitzhak Berlovich decided to use a cash incentive to encourage hospitals to treat these patients more quickly. They arranged that a larger health-fund payment be paid to the hospital in cases when the surgery is performed within 48 hours.
Instead of being paid the per-diem hospitalization rate for a few weeks before and after surgery, the hospitals receive NIS 20,000 per patient for doing the surgery quickly. A diagnosis-related group (DRG) was established by the ministry, which enabled the incentive payment.
Dor said that within one year, there was a 24% increase in the number of hip-joint replacement operations performed within 48 hours. He noted that most people who break their hip joints are elderly and suffer from osteoporosis. If the surgery is not performed quickly, blood clots and other complications can kill them.
Just changing the hospitals' compensation for doing the surgery quickly - encouraging them to hire and make available enough orthopedic surgeons, nurses, anesthesiologists and other personnel - has saved lives, Dor added. Today, nearly every hospital in the country performs hip-joint replacement surgery within 48 hours. To meet the schedules, operations are now performed at night as well as during the day. The health funds, he added, did not voice opposition, since shorter hospital stays save them money, while hospitals are happy because patients are admitted and discharged in about four days and turnover is higher.
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