Health Economics

Hospital finances and productivity: in a critical condition? – The Health Foundation – April 2015

Posted on April 15, 2015. Filed under: Health Economics | Tags: |

Hospital finances and productivity: in a critical condition? – The Health Foundation – April 2015

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Methods for estimation of the NICE cost-effectiveness threshold – Centre for Health Economics, University of York – 19 February 2015

Posted on February 25, 2015. Filed under: Health Economics, Health Technology Assessment |

Methods for estimation of the NICE cost-effectiveness threshold – Centre for Health Economics, University of York – 19 February 2015

About the research programme

“Cost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced.”

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The costs of eating disorders: social, health and economic impacts – beat – beating eating disorders – February 2015

Posted on February 25, 2015. Filed under: Dietetics, Health Economics | Tags: |

The costs of eating disorders: social, health and economic impacts – beat – beating eating disorders – February 2015

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Delivering Universal Health Coverage: A Guide For Policymakers – WISH (World Innovation Summit for Health) – February 2015

Posted on February 25, 2015. Filed under: Health Economics, Health Mgmt Policy Planning |

Delivering Universal Health Coverage: A Guide For Policymakers – WISH (World Innovation Summit for Health) – February 2015

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Rationing in the NHS – Nuffield Trust – 19 February 2015

Posted on February 19, 2015. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

Rationing in the NHS – Nuffield Trust – 19 February 2015

Media release: ‘Messy’ approach to rationing healthcare losing legitimacy: New Nuffield Trust analysis – Nuffield Trust – 19 February 2015

 

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The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2011-2012 – AHRQ – September 2015

Posted on February 18, 2015. Filed under: Health Economics | Tags: |

The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2011-2012 – AHRQ – September 2015

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Investing in children’s mental health : a review of evidence on the costs and benefits of increased service provision – Centre for Mental Health [UK] – 3 February 2015

Posted on February 10, 2015. Filed under: Health Economics, Mental Health Psychi Psychol | Tags: |

Investing in children’s mental health : a review of evidence on the costs and benefits of increased service provision – Centre for Mental Health [UK] – 3 February 2015

News report: Supporting children’s mental health is a good investment, says new report

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Going home alone: counting the cost to older people and the NHS – Royal Voluntary Service – 16 November 2015

Posted on January 22, 2015. Filed under: Aged Care / Geriatrics, Health Economics |

Going home alone: counting the cost to older people and the NHS – Royal Voluntary Service – 16 November 2015

“Lack of support after hospital doubles readmissions for older people”

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Teaching, Training and Research Costing Study Public Consultation Paper – Independent Hospital Pricing Authority (IHPA) – 19 December 2014

Posted on December 19, 2014. Filed under: Health Economics, Research | Tags: , |

Teaching, Training and Research Costing Study Public Consultation Paper – Independent Hospital Pricing Authority (IHPA) – 19 December 2014

“The Independent Hospital Pricing Authority (IHPA) is conducting a Teaching, Training and Research (TTR) costing study to inform the development of a TTR classification. The project involves undertaking a cost and activity data collection across a representative sample of Australian hospitals, and thereby develop a costed data file to inform the development of a TTR classification. IHPA has engaged a consortium, led by Paxton Partners to undertake this costing study.

The purpose of this public consultation paper is to provide an outline of the background, scope and proposed approach to the costing study, so that interested parties can learn about the work IHPA is undertaking and provide written feedback if desired. The paper does not provide comprehensive details of all aspects of the costing study. Instead, certain aspects have been emphasised – such as the high-level costing methodology and approach to data collection.

Interested parties are therefore invited to read the consultation paper, and provide a response to the consultation questions.

Submissions in relation to this document should be sent as an accessible Word document to submissions.ihpa@ihpa.gov.au or posted to ‘Submissions’ PO BOX 483 Darlinghurst NSW 1300. Submissions close at 5pm AEST, 30 January 2015.

All submissions will be published on the IHPA website unless respondents specifically identify any sections that they believe should be kept confidential due to commercial or other reasons.”

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Funding rare disease therapies in Australia: ensuring equitable access to health care for all Australians – McKell Institute – November 2014

Posted on December 11, 2014. Filed under: Health Economics | Tags: , |

Funding rare disease therapies in Australia: ensuring equitable access to health care for all Australians – McKell Institute – November 2014

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Capitation: a potential new payment model to enable integrated care – NHS England – 26 November 2014

Posted on December 10, 2014. Filed under: Health Economics | Tags: |

Capitation: a potential new payment model to enable integrated care – NHS England – 26 November 2014

Extract

“Across the health services sector, there is a move towards offering more integrated care, especially for patients who have multiple long term conditions and need care
from many providers across different care settings. The launch of the ‘Five Year Forward View’1 and the Integrated Personal Commissioning (IPC) programme have added impetus to this trend. However, sector feedback indicates that the current forms of payment does not always support the delivery of more person centred co-ordinated care.

Monitor and NHS England are committed to using the full potential of the payment system to provide better support across the country for innovations in patient centred, co-ordinated care. To enable such innovation, the Health and Social Care Act 2012 provides for payment arrangements to be determined locally rather than nationally,
2 where this will benefit patients.

Capitated payments are one such payment arrangement that several local care economies are developing. Broadly speaking, capitated payment or capitation means paying a provider or group of providers to cover the majority (or all) of the care provided to a target population, such as patients with multiple long term conditions (LTCs), across different care settings. The regular payments are calculated as a lump sum per patient. If a provider meets the specified needs of the target population for less than the capitated payment, they will generate a financial gain to the local health system. Allowing providers to share in any such gain gives them an added incentive to keep patients in their target population healthy. They are more likely to identify risks, intervene early and arrange the right treatment for patients, at the right place and the right time to aid patients’ recovery, continued wellness and better management of long term conditions.”

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Overcoming obesity: An initial economic analysis – McKinsey & Company – November 2014

Posted on November 24, 2014. Filed under: Health Economics, Public Hlth & Hlth Promotion | Tags: , |

Overcoming obesity: An initial economic analysis – McKinsey & Company – November 2014

“A new McKinsey Global Institute (MGI) discussion paper, Overcoming obesity: An initial economic analysis, seeks to overcome these hurdles by offering an independent view on the components of a potential strategy. MGI has studied 74 interventions (in 18 areas) that are being discussed or piloted somewhere around the world to address obesity, including subsidized school meals for all, calorie and nutrition labeling, restrictions on advertising high-calorie food and drinks, and public-health campaigns. We found sufficient data on 44 of these interventions, in 16 areas.”

… continues

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The costs of perinatal mental health problems – Centre for Mental Health and London School of Economics – October 2014

Posted on October 24, 2014. Filed under: Health Economics, Mental Health Psychi Psychol, Obstetrics |

The costs of perinatal mental health problems – Centre for Mental Health and London School of Economics – 20 October 2014

“This report sets out the findings of a project on the economic and social impact of maternal mental health problems in the perinatal period, defined as the period during pregnancy and the first year after childbirth.”

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Exploring the costs of unsafe care in the NHS – Frontier Economics – 16 October 2014

Posted on October 24, 2014. Filed under: Health Economics, Patient Safety |

Exploring the costs of unsafe care in the NHS – Frontier Economics – 16 October 2014

“This report, commissioned by the Department of Health, investigates the costs of unsafe care in the NHS. A rapid review of existing evidence suggests that the costs of preventable, adverse events is likely to be more than £1 billion per year, but could be up to £2.5 billion annually.”

Media release – Unsafe care costs the English NHS over £1 billion a year says Frontier report
http://www.frontier-economics.com/news/unsafe-care-costs-the-english-nhs-over-1-billion-a-year-says-frontier-report/

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Financial failure in the NHS: What causes it and how best to manage it – The King’s Fund – 9 October 2014

Posted on October 13, 2014. Filed under: Health Economics | Tags: |

Financial failure in the NHS: What causes it and how best to manage it – The King’s Fund – 9 October 2014

“This report describes the current financial state of the NHS and the reasons for the deterioration in financial performance and ultimately financial failure. These include weak leadership, legacy costs, PbR, and the impact of the wider health economy.
It considers the challenge of the conflict between quality of care and financial balance and sets out the approaches used to avert financial failure and to deal with it once it occurs. The role of ‘bail-outs’, loans, Public Dividend Capital, increased tariffs, whole health economy solutions, mergers and the importance of leadership are all considered. The report then sets out some recommendations for the future.”

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Guidance on conducting a situation analysis of health financing for universal health coverage – WHO – 25 August 2014

Posted on September 25, 2014. Filed under: Health Economics | Tags: , |

Guidance on conducting a situation analysis of health financing for universal health coverage – WHO – 25 August 2014

“The purpose of this paper is to provide guidance to undertake a situation analysis of a country’s health financing system and assess the existing system relative to the goal of universal health coverage (UHC, also called universal coverage). In turn, the purpose of the situation analysis is to inform a health financing reform strategy. Such an analysis will provide detailed insights into where the existing system is performing well or poorly, a diagnosis of the reasons why, and the challenges the country faces in moving towards universal coverage. A good situation analysis thus provides the “starting point” for a national health financing reform strategy.”

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Health expenditure Australia 2012-13 – AIHW – 23 September 2014

Posted on September 23, 2014. Filed under: Health Economics |

Health expenditure Australia 2012-13 – AIHW – 23 September 2014

“Expenditure on health in Australia was estimated to be $147.4 billion in 2012–13, 1.5% higher than in 2011–12 and the lowest growth since the mid 1980’s. In 2012–13, governments provided $100.8 billion (or 68.3%) of total health expenditure. Government funding of health expenditure fell in real terms for the first time in the decade by 0.9%, largely a result of a decline in Australian Government funding of 2.4%. State and territory government funding was also relatively low, growing just 1.4% in real terms in 2012–13. In contrast, growth in non-government funding was relatively strong at 7.2%.”

ISSN 1323-5850; ISBN 978-1-74249-640-5; Cat. no. HWE 61; 150pp

Health spending growth slowest since the 1980s – AIHW media release – 23 September 2014

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Programme Budgeting and Marginal Analysis (PBMA) A Reading List produced by NHS Right Care – July 2014

Posted on July 23, 2014. Filed under: Health Economics | Tags: |

Programme Budgeting and Marginal Analysis (PBMA) A Reading List produced by NHS Right Care – July 2014

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Definition of a frame of reference in relation to primary care with a special emphasis on financing systems and referral systems – European Commission EXpert Panel on Effective Ways of Investing in Health (EXPH) – 10 July 2014

Posted on July 22, 2014. Filed under: Health Economics, Primary Hlth Care | Tags: |

Definition of a frame of reference in relation to primary care with a special emphasis on financing systems and referral systems – European Commission EXpert Panel on Effective Ways of Investing in Health (EXPH) – 10 July 2014

“Abstract

In this opinion the Expert Panel on effective ways of investing in Health (EXPH), considers primary care to be the provision of universally accessible, integrated, person-centred, comprehensive health and community services, provided by a team of professionals accountable for addressing a large majority of personal health needs. These services are delivered in a sustained partnership with patients and informal care givers, in the context of family and community and play a central role in the overall coordination and continuity of people’s care.

The professionals active in primary care teams include, among others, dentists, dieticians, general practitioners/family physicians, nurses, occupational therapists, optometrists, pharmacists, physiotherapists, psychologists and social workers.

The Expert Panel notes that strong primary care systems contribute to equity and improved health outcomes but emphasises that primary care needs to continuously evolve if it is to respond to changing challenges in society.

A strong primary care system can be the starting point for effective referral and discharge systems, ensuring integration between different levels of care. Gate-keeping can offer advantages to patients, providers and the health system so long as important organisational and patient management factors are taken into account.

The Expert Panel emphasizes the importance of ensuring that primary care services are accessed by the population without facing financial hardship and notes that there is little evidence that user charges lead to more appropriate use and cost control. When user charges are present, there should be mechanisms to protect people with low incomes and those who regularly use health care.

European Union (EU) health systems show a trend towards blended provider payment systems in primary care, combining risk-adjusted capitation with some fee-for-service reimbursement. The Expert Panel describes factors that may contribute to the effectiveness of pay-for-performance (P4P) programs and implementation features that may weaken the effectiveness of financial incentives.

Finally, the Expert Panel formulates general research questions in relation to the development of primary care in Europe, specific research questions in relation to referral
and financing and strategic directions at different levels. ”

doi:10.2772/33238

 

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Defining Health and Health Care Sustainability – The Conference Board of Canada, 72 pages, July 2014

Posted on July 22, 2014. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

Defining Health and Health Care Sustainability – The Conference Board of Canada, 72 pages, July 2014

“Canadian health care costs are soaring and major reforms are needed to preserve and improve the quality of health care. This report develops a sustainability framework with guiding principles and key factors deemed essential to support sustainable health care.

Document Highlights

Health care costs currently absorb about 11 per cent of Canada’s gross domestic product and almost half of provincial budgets. We will not be able to preserve, let alone improve, the quality of our health care without major reforms. To meet this challenge—the fiscally unsustainable public health care system in Canada—the Conference Board’s Canadian Alliance for Sustainable Health Care (CASHC) program researched and analyzed the issues and options for solution.

This report defines sustainability and presents a sustainability framework to guide CASHC’s policy work and future recommendations on health care. The definition and framework follow an extensive literature review and comprehensive interviews with representatives of health care stakeholders.

The sustainability framework has four guiding principles and six key factors deemed essential to support sustainable health and health care. While these may not be new to the reader, the innovation in the report comes from their systematic implementation across the continuum of care, across diseases, and across departments controlling determinants of health in order to create a well-functioning system.”

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Making Mental Health Count: The Social and Economic Costs of Neglecting Mental Health Care – OECD – 8 July 2014

Posted on July 11, 2014. Filed under: Health Economics, Mental Health Psychi Psychol | Tags: |

Making Mental Health Count: The Social and Economic Costs of Neglecting Mental Health Care – OECD – 8 July 2014

“Despite the enormous burden that mental ill-health imposes on individuals, their families, society, health systems and the economy, mental health care remains a neglected area of health policy in too many countries. Mental disorders represent a considerable disease burden, and have a significant impact on the lives of the OECD population, and account for considerable direct and indirect costs. This report argues that even in those OECD countries with a long history of deinstitutionalisation, there is still a long way to go to make community-based mental health care that achieves good outcomes for people with severe mental illness a reality. The disproportionate focus on severe mental illness has meant that mild-to-moderate mental illnesses, which makes up the largest burden of disease, have remained overwhelmingly neglected. This book addresses the high cost of mental illness, weaknesses and innovative developments in the organisation of care, changes and future directions for the mental health workforce, the need to develop better indicators for mental health care and quality, and tools for better governance of the mental health system. The high burden of mental ill health and the accompanying costs in terms of reduced quality of life, loss of productivity, and premature mortality, mean that making mental health count for all OECD countries is a priority.”

ISBN : 9789264208445 (PDF) ; 9789264208438 (print)
DOI : 10.1787/9789264208445-en

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Into the Red? The State of the NHS’ Finances – Nuffield Trust – 10 July 2014

Posted on July 11, 2014. Filed under: Health Economics | Tags: , |

Into the Red? The State of the NHS’ Finances – Nuffield Trust – 10 July 2014

“This report shows that, after holding up well under austerity since 2010, the NHS’ finances are starting to come under severe financial pressure.”

 

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Estimating the Economic Returns on Cancer Research in the UK – RAND – 2014

Posted on June 19, 2014. Filed under: Health Economics, Oncology, Research | Tags: |

Estimating the Economic Returns on Cancer Research in the UK – RAND – 2014

“In recent years, researchers and funders have aimed to better understand the range of impacts arising from public and charitable funding for medical research — including the resulting economic benefits. Such information provides accountability to taxpayers and charity donors, and increases our understanding of how research effectively translates to health gains. Financial returns may not be a key driver in research decisions, but the demands on public funding are substantial and it is therefore important to evaluate investment in research.

While it is easy to cite examples of breakthroughs that have led to substantial patient benefits or improvements in quality of life, it is more difficult to assess the nature and extent of the economic returns arising from investment in a whole body of medical research, some of which may inevitably be less fruitful.
Goals

This study, led by RAND Europe, the Health Economics Research Group (HERG) at Brunel University and King’s College London, aimed to estimate the returns generated by public and charitable investment in UK research. The work focuses on cancer and followed a ground-breaking study published in 2008, which yielded the first quantitative assessment of the economic benefit of biomedical and health science in the UK. The original report focused on the returns generated from investment in cardiovascular disease research, also testing the methodology to a more limited extent on mental health research.”

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Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering [Report to the President] – President’s Council of Advisors on Science and Technology – May 2014

Posted on June 18, 2014. Filed under: Health Economics, Health Systems Improvement | Tags: |

Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering [Report to the President] – President’s Council of Advisors on Science and Technology – May 2014

Extract:

“Dear Mr. President,

We are pleased to send you this report by your Council of Advisors on Science and Technology, Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering. This report comes at a critical time for the United States. Health-care costs now approach a fifth of the U.S. economy, yet a significant portion of those costs is reportedly “unnecessary” and does not lead to better health or quality of care. Millions more Americans now have health insurance and therefore access to the health care system as a result of the Affordable Care Act (ACA). With expanded access placing greater demands on the health-care system, strategic measures must be taken not only to increase efficiency, but also to improve the quality and affordability of care.

This report, which was informed by the deliberations of a working group comprised of PCAST members and prominent health-care and systems-engineering experts, identifies a comprehensive set of actions for enhancing health care across the Nation through greater use of systems-engineering principles. Systems engineering, widely used in manufacturing and aviation, is an interdisciplinary approach to analyze, design, manage, and measure a complex system in order to improve its efficiency, reliability, productivity, quality, and safety. It has often produced dramatically positive results in the small number of health-care organizations that have incorporated it into their processes. But in spite of excellent examples, systems methods and tools are not yet used on a widespread basis in U.S. health care.”

… continues on the site

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What is the evidence on the economic impacts of integrated care? – European Observatory on Health Systems and Policies (EOHSP) – 6 June 2014

Posted on June 10, 2014. Filed under: Health Economics | Tags: , , , |

What is the evidence on the economic impacts of integrated care? – European Observatory on Health Systems and Policies (EOHSP) – 6 June 2014

News release: What is the evidence on the economic impacts of integrated care?

“This new policy summary reviews the existing evidence on the economic impact of integrated care approaches. Whereas it is generally accepted that integrated care models have a positive effect on the quality of care, health outcomes and patient satisfaction, it is less clear how cost effective they are. As the evidence-base in this field is rather weak, the authors suggest that we may have to revisit our understanding of the concept and our expectations in terms of its assessment.

Integrated care should rather be seen as a complex strategy to innovate and implement long-lasting change in the way services in the health and social-care sectors are delivered.

This policy summary (number 11) is based on a report for the European Commission to inform the discussions of the EU’s Reflection process on modern, responsive and sustainable health systems on the objective of integrated care models and better hospital management. Both authors are affiliated to RAND Europe.”

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Study: Experimental measures of output and productivity in the Canadian hospital sector, 2002 to 2010 – Statistics Canada – 23 April 2014

Posted on May 5, 2014. Filed under: Health Economics, Workforce | Tags: , |

Study: Experimental measures of output and productivity in the Canadian hospital sector, 2002 to 2010 – Statistics Canada – 23 April 2014

“Using new experimental measures of economic output for hospitals, the research paper “Experimental Measures of Output and Productivity in the Canadian Hospital Sector” provides estimates of labour productivity in Canada’s hospital sector.

Labour productivity is a measure of economic output per unit of labour input. The labour input is measured by the total hours worked of doctors, nurses and administrative staff. However, up until now, little was known about the sector’s productivity because of the way economic output was measured.

In the past, the volume of output was measured by the volume of inputs, such as labour costs for doctors, nurses and administrative staff, as well as capital input. This did not allow for a measure of productivity performance for the sector.

This study produced an experimental direct output measure by using the number of inpatient and outpatient cases by type for the Canadian hospital sector to estimate a measure of the sector’s productivity.

The output measure is based on the notion that the output in hospitals represents the treatment of a disease or condition. As treatments of different diseases and conditions involve different types of services, weights based on unit costs of treatments for each type of inpatient and outpatient case are applied to establish the direct output measure.

The study estimates that labour productivity in the hospital sector increased 2.6% per year on average over the 2002-to-2010 period. This represents annual growth of 4.3% for output and 1.7% for hours worked in the sector.

The labour productivity growth in hospitals was greater than the annual growth of 0.7% for the business sector over the same period.”

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Weight Management Economic Assessment Tool [for public health professionals] – Public Health England – 28 April 2014

Posted on May 1, 2014. Filed under: Health Economics, Preventive Healthcare, Public Hlth & Hlth Promotion | Tags: |

Weight Management Economic Assessment Tool [for public health professionals] – Public Health England – 28 April 2014

“The newly developed tool will help local authorities (LAs) to assess the financial benefit of adult weight management programmes to prevent and reduce obesity. LAs will now be able to compare the cost of a programme with potential future healthcare savings that may result. This will help them in their ongoing efforts to achieve a decline in obesity rates by 2020.

The tool estimates the health impact of weight loss in any group of adults who have participated in a programme. The tool is accessible, easy to use and allows users to enter their own local data which will produce forecasts for up to 25 years.”

… continues on the site

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How much does high quality care cost? – Foundation Trust Network [UK] – 25 April 2014 Member briefing

Posted on May 1, 2014. Filed under: Health Economics | Tags: |

How much does high quality care cost? – Foundation Trust Network [UK] – 25 April 2014 Member briefing

Infographic

News release – FTN survey shows £1.2 billion being spent by NHS trusts on Francis and Keogh implementation – 25 April 2014

 

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The NHS productivity challenge: Experience from the front line – The King’s Fund – 1 May 2014

Posted on May 1, 2014. Filed under: Health Economics | Tags: , |

The NHS productivity challenge: Experience from the front line – The King’s Fund – 1 May 2014

“The unprecedented slowdown in the growth of NHS funding in England since 2010 required the NHS to pursue the most ambitious programme of productivity improvement since its foundation. It has broadly risen to the challenge, with pay restraint, cuts in central budgets, and the abolition of some tiers of management producing significant savings. But the strongest pressure has been applied and felt at the front line, by hospitals and other local service providers, faced with squeezing more and more value from every health care pound.

This report describes how six trusts have been grappling with the productivity challenge. It also suggests ways to divert the NHS and social care from their current trajectory, which is heading towards a major crisis.”

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Measuring the Level and Determinants of Health System Efficiency in Canada – Canadian Institute for Health Information – 10 April 2014

Posted on April 23, 2014. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

Measuring the Level and Determinants of Health System Efficiency in Canada – Canadian Institute for Health Information – 10 April 2014

“This study measures health system efficiency in Canada to gain insight into factors that help explain variations in efficiency at the health region level. The study builds on findings from the CIHI report Developing a Model for Measuring the Efficiency of the Health System in Canada and examines questions such as why some of Canada’s health regions are more efficient than others.”

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Exploring Accountable Care in Canada: Integrating Financial and Quality Incentives for Physicians and Hospitals – Canadian Foundation for Healthcare Improvement – 1 April 2014

Posted on April 23, 2014. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

Exploring Accountable Care in Canada: Integrating Financial and Quality Incentives for Physicians and Hospitals – Canadian Foundation for Healthcare Improvement – 1 April 2014

“ACOs are promising vehicles for aligning physician and hospital interests in improving quality and reducing cost. However, successful implementation and realization of the ACO mission requires that attention be paid to supporting capacity building within the ACOs, development of a culture of learning and improvement, as well as rigorous monitoring and evaluation. While the jury is still out on success of ACO implementation efforts in the United States, the results presented here suggest that further exploration of their potential in Canada is warranted, and that distinct characteristics of the Canadian system might require a slightly different approach.”

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Why Income Gaps Matter – Policy Quarterly – February 2014

Posted on April 16, 2014. Filed under: Health Economics, Public Hlth & Hlth Promotion | Tags: |

Why Income Gaps Matter – Policy Quarterly – February 2014

“The income gap between rich and poor, which is now much larger in most developed countries than it was 30 years ago, has become one of the more pressing problems facing both the public and policy makers. One approach to this problem of (in)equality is to argue that the income gaps themselves are concerning, and should be narrowed. If we think of the income distribution as a ladder, this is the equivalent of saying that the rungs on the ladder are too far apart. A second approach, however, is to say that income gaps per se are not of concern; what matters is whether people can move freely between those different incomes – whether they can jump, as it were, from one rung to another. There are still other approaches, of course, but the contrast between these two is very revealing and merits closer scrutiny.”

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Investing in recovery: rethink mental illness: Making the business case for effective interventions for people with schizophrenia and psychosis – London School of Economics and the Centre for Mental Health – 10 April 2014

Posted on April 14, 2014. Filed under: Health Economics, Mental Health Psychi Psychol |

Investing in recovery: rethink mental illness: Making the business case for effective interventions for people with schizophrenia and psychosis – London School of Economics and the Centre for Mental Health – 10 April 2014

Press release: The NHS will pay a high price for short-term mental health cuts – 10 April 2014

 

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Measuring the Level and Determinants of Health System Efficiency in Canada – Canadian Institute for Health Information – 10 April 2014

Posted on April 14, 2014. Filed under: Health Economics, Health Systems Improvement | Tags: , , |

Measuring the Level and Determinants of Health System Efficiency in Canada – Canadian Institute for Health Information – 10 April 2014

Public summary: Health system efficiency in Canada: A closer look

Press release: More efficient health system would save lives, money

“…the Canadian Institute for Health Information (CIHI) released a new study on the efficiency of the Canadian health system. Measuring the Level and Determinants of Health System Efficiency in Canada examines why health system efficiency varies across Canada, what could be done about it, and what a perfectly efficient health system might look like.

The study estimates the average level of inefficiency to be between 18% and 35%. This means that up to 24,500 premature deaths could be prevented every year—without additional spending.”

… continues on the site

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European Hospital Survey – Benchmarking Deployment of eHealth services (2012-2013) – European Commission – 24 March 2014

Posted on April 3, 2014. Filed under: Health Economics | Tags: |

European Hospital Survey – Benchmarking Deployment of eHealth services (2012-2013) – European Commission – 24 March 2014

“A survey carried out in about 1,800 hospitals in the 28 EU countries plus Iceland and Norway measures the level of deployment and take-up of ICT and eHealth applications in acute care hospitals in Europe.

The survey, carried out by PwC EU Services in cooperation with Global Data Collection Company, covered i) ICT Infrastructure, ii) ICT Applications, iii) Health Information Exchange and iv) Security and Privacy. Based on the survey results, the Joint Research Centre IPTS developed two composite indicators on eHealth deployment and eHealth availability & use and made a comparison with a previous survey carried out in 2010. The results suggest that the deployment of eHealth in European acute care hospitals has increased over the period 2010-2013 (from an average of 0.39 to 0.42 in a range of 0 to 1). Moreover, the gap between best performers (mostly Nordic countries) and less advanced countries (mostly Eastern European and Greece) in hospital eHealth deployment has narrowed. Advanced eHealth functionalities are not widely used across hospitals, however, when available, they are quite popular. For example, digital archiving of radiology images is available in just 53% of EU hospitals, but in almost all of these (92%) it is fully used.

The results also suggest that connectivity is still lagging behind, as most of the hospitals do not share electronically medical information that they produce/store in this format. Finally, the vast majority of hospitals do not allow patients to access their complete health records online thus preventing more involvement in their healthcare.
Top performing countries for eHealth deployment among hospitals are Denmark (66%), Estonia (63%), Sweden and Finland (both 62%). Full country profiles are available (see below).

The study “European Hospital Survey- Benchmarking Deployment of eHealth services (2012-2013)” is composed of the following reports:”

… continues on the site

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Social care for older people – The Health Foundation and Nuffield Trust – 26 March 2014

Posted on March 27, 2014. Filed under: Aged Care / Geriatrics, Health Economics | Tags: , |

Social care for older people – The Health Foundation and Nuffield Trust – 26 March 2014

“Budget allocations from central Government to English local authorities were reduced by 14% in real terms between 2011/12 and 2014/15. This report asks how local authorities have responded to this decline in income and explores the possible impact on older adults’ health and wellbeing.”

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Unit Costs of Health and Social Care 2013 – Personal Social Services Research Unit – published 12 March 2014

Posted on March 13, 2014. Filed under: Health Economics |

Unit costs of health and social care

“This report brings together information about the costs of health and social care staff and services in as transparent and consistent a way as possible. The report is based in economic theory (long run marginal opportunity cost) and includes detailed references, relevant short articles and commentaries.”

Unit Costs of Health and Social Care 2013 – Personal Social Services Research Unit – published 12 March 2014

Contents:

Widening the scope of unit costs to include environmental costs
John Appleby, Chris Naylor and Imogen Tennison

Cognitive behaviour therapy: a comparison of costs
Barbara Barrett and Hristina Petkova

Residential child care: costs and other information requirements
Jonathan Stanley and Andrew Rome

The costs of telecare and telehealth
Catherine Henderson, Jennifer Beecham and Martin Knapp

I Services –
1.Services for older people
2.Services for people with mental health problems
3.Services for people who misuse drugs or alcohol
4.Services for people with learning disabilities
5.Services for adults with physical disabilities
6.Services for children and their families
7.Hospital and other services
8.Care packages

II Community-based health care staff
9.Scientific and professional
10.Nurses and doctors

III Community-based social care
11.Social care staff
12.Health and social care teams
IV Hospital-based health care staff
13.Hospital based scientific and professional staff
14.Hospital based-nurses
15.Hospital based-doctors

V Sources of information
16.Inflation indices
17.NHS staff earning estimates
18.Care home fees
19.Glossary
20.References
21.Index of references
22.List of useful sources
23.List of items from previous volumes not included in this volume

 

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The Importance of Multimorbidity in Explaining Utilisation and Costs Across Health and Social Care Settings: Evidence from South Somerset’s Symphony Project – University of York, Centre for Health Economics – February 2014

Posted on March 12, 2014. Filed under: Chronic Disease Mgmt, Health Economics | Tags: , |

The Importance of Multimorbidity in Explaining Utilisation and Costs Across Health and Social Care Settings: Evidence from South Somerset’s Symphony Project – University of York, Centre for Health Economics – February 2014

Abstract

Aims
Since the inception of the NHS, an ever-present challenge has been to improve integration of care within the health care system and with social care. Many people have complex and ongoing care needs and require support from multiple agencies and various professionals. But care is often fragmented and uncoordinated, with no one agency taking overall responsibility, so it is often left to individuals and their families to negotiate the system as best they can. South Somerset’s Symphony is designed to establish greater collaboration between primary, community, acute and social care, particularly for people with complex conditions.

Methods
We examine patterns of health and social care utilisation and costs for the local population to identify which groups of people would most benefit from better integrated care. We analyse data to identify groups of people according to the frequency of occurrence of underlying conditions; the cost of care; and utilisation of services across diverse settings. The empirical identification strategy is supplemented by local intelligence gained through workshops with health and social care professionals about the appropriateness of existing patterns of provision. We employ two-part regression models to explain variability in individual health and social costs, in total and in each setting.

Data
The Symphony Project has an anonymised individual-level dataset, spanning primary, community, acute, mental health and social care. This includes activity, costs, clinical conditions, age, sex and ward of residence for the entire population of 114,874 people in 2012. Each person’s morbidity profile is described using the United Health’s Episode Treatment Groups (ETG), which build upon ICD and Read codes.

Results
We identify the frequency of conditions and co-morbidity profile of the entire population and, for the most frequent conditions, we assess utilization and costs of care across health and social care settings. For example, for those with asthma and diabetes, hospital costs account for the largest proportion of costs; in contrast, costs for those with dementia occur mostly in social care, mental health care and community care settings. For the population as a whole, we find that costs of health and social care are driven more by an individual’s morbidity profile than by their age. Data for those with the most frequent conditions were reviewed by local health and social care professionals and managers. It was decided to undertake more detailed analyses for those with diabetes or dementia. 5,676 people are recorded as having diabetes in South Somerset, with hypertension being the most common comorbidity. For those with a sole diagnosis of diabetes, costs are around £1,000 on average but as people are recorded as having more diagnoses, average costs increase progressively. Costs are also higher for older people and women.People with dementia account for only 0.92% of the South Somerset population, but the average annual cost for the 1,062 people with dementia is around £12,000. A high proportion of these costs are related to the provision of mental health, social and continuing care. Costs are higher the more co-morbidities a person has, and for people from more deprived areas. Age and gender do not explain variation in costs for people with dementia.

Conclusions
This work forms a basis for identifying groups that would most benefit from improved integrated care, which might be facilitated by integrated financial arrangements and better pathway management. The more co-morbidities that a person has, the more likely they are to require care across diverse settings, and the higher their costs. Our analysis identifies those groups of the population which are the highest users of services by activity and cost and provides baseline information to allow budgetary arrangements to be developed for these targeted groups.

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Education and training tariffs: tariff guidance for 2014-15 – England Department of Health – 6 March 2014

Posted on March 10, 2014. Filed under: Educ for Hlth Professions, Health Economics |

Education and training tariffs: tariff guidance for 2014-15 – England Department of Health – 6 March 2014

“This document sets out:

the national tariffs for healthcare education and training placements in the financial year 2014 to 2015
how the tariffs will be implemented
in what circumstances the national tariffs may be varied and how to do this

The tariffs cover non-medical placements and medical undergraduate and postgraduate placements in secondary care.

Guidance on the tariffs will be published once a year, to cover the tariffs for the following financial year. Any further information that arises during the year will be published on Health Education England’s website.”

 

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Examining variations in hospital productivity in the English NHS – European Journal of Health Economics – February 2014

Posted on March 6, 2014. Filed under: Health Economics |

Examining variations in hospital productivity in the English NHS – European Journal of Health Economics – February 2014 – Open Access

“Objectives
Numerous papers have measured hospital efficiency, mainly using a technique known as data envelopment analysis (DEA). A shortcoming of this technique is that the number of outputs for each hospital generally outstrips the number of hospitals. In this paper, we propose an alternative approach, involving the use of explicit weights to combine diverse outputs into a single index, thereby avoiding the need for DEA.

Methods
Hospital productivity is measured as the ratio of outputs to inputs. Outputs capture quantity and quality of care for hospital patients; inputs include staff, equipment, and capital resources applied to patient care. Ordinary least squares regression is used to analyse why output and productivity varies between hospitals. We assess whether results are sensitive to consideration of quality.

Results
Hospital productivity varies substantially across hospitals but is highly correlated year on year. Allowing for quality has little impact on relative productivity. We find that productivity is lower in hospitals with greater financial autonomy, and where a large proportion of income derives from education, research and development, and training activities. Hospitals treating greater proportions of children or elderly patients also tend to be less productive.

Conclusions
We have set out a means of assessing hospital productivity that captures their multiple outputs and inputs. We find substantial variation in productivity among English hospitals, suggesting scope for productivity improvement.”

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Measuring Success in Health Care Value-Based Purchasing Programs: Findings from an Environmental Scan, Literature Review, and Expert Panel Discussions – RAND – March 2014

Posted on March 5, 2014. Filed under: Health Economics | Tags: |

Measuring Success in Health Care Value-Based Purchasing Programs: Findings from an Environmental Scan, Literature Review, and Expert Panel Discussions – RAND – March 2014

“Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to health care providers’ performance on a set of defined measures in an effort to achieve better value. The U.S. Department of Health and Human Services is advancing the implementation of VBP across an array of health care settings in the Medicare program in response to requirements in the 2010 Patient Protection and Affordable Care Act, and policymakers are grappling with many decisions about how best to design and implement VBP programs so that they are successful in achieving stated goals.

This report summarizes the current state of knowledge about VBP based on a review of the published literature, a review of publicly available documentation from VBP programs, and discussions with an expert panel composed of VBP program sponsors, health care providers and health systems, and academic researchers with VBP evaluation expertise. Three types of VBP models were the focus of the review: (1) pay-for-performance programs, (2) accountable care organizations, and (3) bundled payment programs. The authors report on VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high- and low-performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base.”

Measuring Success in Health Care Value-Based Purchasing Programs: Summary and Recommendations – RAND – March 2014

“Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to health care providers’ performance on a set of defined measures in an effort to achieve better value. The U.S. Department of Health and Human Services (HHS) is advancing the implementation of VBP across an array of health care settings in the Medicare program in response to requirements in the 2010 Patient Protection and Affordable Care Act, and policymakers are grappling with many decisions about how best to design and implement VBP programs so that they are successful in achieving stated goals.

This report summarizes the current state of knowledge about VBP programs, focusing on pay-for-performance programs, accountable care organizations, and bundled payment programs. The authors discuss VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high- and low-performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base. The report concludes with a set of recommendations for the design, implementation, and monitoring and evaluation of VBP programs and a discussion of HHS’s efforts in this regard.”

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The importance of multimorbidity in explaining utilisation and costs across health and social care settings: evidence from South Somerset’s Symphony Project – University of York, Centre for Health Economics – February 2014

Posted on March 5, 2014. Filed under: Chronic Disease Mgmt, Health Economics | Tags: , |

The importance of multimorbidity in explaining utilisation and costs across health and social care settings: evidence from South Somerset’s Symphony Project – University of York, Centre for Health Economics – February 2014

Panos Kasteridis, Andrew Street, Matthew Dolman, Lesley Gallier, Kevin Hudson, Jeremy Martin and Ian Wyer

“Abstract
Aims
Since the inception of the NHS, an ever-present challenge has been to improve integration of care within the health care system and with social care. Many people have complex and ongoing care needs and require support from multiple agencies and various professionals. But care is often fragmented and uncoordinated, with no one agency taking overall responsibility, so it is often left to individuals and their families to negotiate the system as best they can. South Somerset’s Symphony is designed to establish greater collaboration between primary, community, acute and social care, particularly for people with complex conditions.”

… continues on the sites

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Controlling the cost of care: a billion dollar hospital opportunity – Grattan Institute – 4 March 2014

Posted on March 5, 2014. Filed under: Acute Care, Health Economics, Health Mgmt Policy Planning | Tags: |

Controlling the cost of care: a billion dollar hospital opportunity – Grattan Institute – 4 March 2014

by Stephen Duckett and Peter Breadon

“A better pricing system for public hospital treatment would show where costs are too high, and free up $1 billion for more and better health care.

The gulf between treatments in high and low-cost hospitals in Australia is vast, with no good reason for such variation. In New South Wales, for example, the difference in the cost of a common gall bladder treatment between the highest and lowest-cost hospitals is more than $4,000, and the difference in the cost of a hip replacement more than $16,000. In many states the gap between the most and least expensive hospitals is more than $1,500 for every admission — and in some states it is much greater — even when all legitimate funding differences among hospitals that we can measure are taken into account.

This money is not being used to provide better care – it is simply being spent inefficiently and could be used for much better ends.

To achieve the savings, the report urges state governments to make three reforms. They should pay hospitals for treatments on the basis of an average price once all avoidable costs we can measure have been removed.

Second, they should make data available to hospitals so they can compare themselves to their peers and see where they can cut costs. Third, governments need to be tougher and hold hospital boards to account when they fail to control costs. But even with these changes, it is up to hospital leaders, managers and doctors to find the best ways to improve.

Hospital spending is the fastest growing area of government spending, and is projected to increase with new technologies and an ageing population. We have to keep health care affordable and the health budget under control. Rooting out inefficiencies in public hospital systems is a good place to start.”

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Empty pockets: why co-payments are not the solution – Consumers Health Forum of Australia – 4 March 2014

Posted on March 4, 2014. Filed under: Health Economics | Tags: , |

Empty pockets: why co-payments are not the solution – Consumers Health Forum of Australia – 4 March 2014

“A new report about health co-payments has been released today by the Consumers Health Forum of Australia (CHF). CHF says the evidence shows that introducing co-payments for health care will hit the chronically ill and people on low incomes the hardest … and will fail to generate cost savings for the health system.”

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Independent Hospital Pricing Authority releases National Efficient Price and National Efficient Cost for Australian public hospital services – 3 March 2014

Posted on March 4, 2014. Filed under: Health Economics | Tags: , , , |

Independent Hospital Pricing Authority releases National Efficient Price and National Efficient Cost for Australian public hospital services – 3 March 2014

“The Independent Hospital Pricing Authority (IHPA) today released the National Efficient Price (NEP) and National Efficient Cost (NEC) Determinations for Australian public hospital services for 2014-15

The NEP and NEC determine the Commonwealth funding contribution to Australian public hospitals according to either hospital activity levels, or in the case of small rural hospitals, an allocation of block funding.

The NEP underpins Activity Based Funding and will apply to approximately 260 public hospitals nationwide including all of the large metropolitan hospitals.

For the first time, from 1 July 2014 the Commonwealth funding for most public hospital services will be directly determined by Activity Based Funding. Under the new system public hospitals are paid for the number and mix of patients they treat. ”

… continues on the site

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Closing the NHS funding gap: Can it be done through greater efficiency? – The Health Foundation – February 2014

Posted on February 28, 2014. Filed under: Health Economics | Tags: , |

Closing the NHS funding gap: Can it be done through greater efficiency? – The Health Foundation – February 2014

“Recently, the Health Foundation brought together senior health sector leaders to consider whether the NHS can close the £30bn funding gap through greater efficiency.

The discussion was stimulated by Monitor’s publication last year of Closing the NHS funding gap: how to get better value healthcare for patients which highlighted the financial challenges facing the NHS in England. The report identified four key areas where there were opportunities to make significant productivity gains across the NHS by 2021 and beyond:

improving productivity within existing services
delivering the right care in the right setting
developing new ways of delivering care
allocating spending more rationally.

While the original intention had been to focus the roundtable discussion around the 2021 challenge, it quickly became clear that there was a more immediate hurdle to clear first – the financial pressures facing the system in 2014/15 and 2015/16.

This report highlights the following key points from the presentations and discussions on the day:”

… continues on the site

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NHS payment reform: lessons from the past and directions for the future – Nuffield Trust – 20 February 2014

Posted on February 21, 2014. Filed under: Health Economics | Tags: |

NHS payment reform: lessons from the past and directions for the future – Nuffield Trust – 20 February 2014

“This policy response reviews different approaches to payment for health services in the English NHS. It explores the evidence on whether recent payment initiatives have met their goals.

The health service has historically been a leader among public services in embracing innovation in payment systems. A wide range of different approaches to payment are now in place for different sectors and different areas, often introduced specifically to drive quality, volume or productivity improvements.

If the NHS is to improve the efficiency of the health system as a whole, it needs payment systems that cover the continuum of care and which create incentives for providing the ‘right care in the right setting’
Anita Charlesworth, Chief Economist, Nuffield Trust and co-author

This policy response looks at options for development of the payment reform system in England. It recommends that any changes are targeted on where they are likely to have the greatest impact, and aligned with wider system changes. The authors also call for any changes to be transparent and evidence-based, as well as predictable and credible.

This policy response is published alongside a research report, The NHS payment system: evolving policy and emerging evidence, which looks at the evidence on whether recent payment initiatives have met their goals.”

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The Trans Pacific Partnership Agreement negotiations and the health of Australians: A policy brief – UNSW – February 2014

Posted on February 19, 2014. Filed under: Health Economics, Public Hlth & Hlth Promotion |

Hirono, K., Gleeson, D., Haigh, F., Harris, P. (2014). The Trans Pacific Partnership Agreement negotiations and the health of Australians: A policy brief. Centre for Health Equity Training, Research and Evaluation, Centre for Primary Health Care and Equity, UNSW Australia.

Extract from the executive summary

“This policy brief examines the potential impact of provisions proposed for the TPPA on the health of Australians, focusing on two specific issues: the cost of medicines, and the ability of government to take major steps to improve the health of Australians by regulating the areas of tobacco and alcohol policy. In each of these areas we trace some of the pathways through which provisions that have been proposed for the TPPA may impact on the health of the Australian population, and the health of specific groups within the population. We highlight the ways in which some of the expected economic gains from the TPPA may be undermined by health and economic costs.”

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AMA Public Hospital Report Card 2014 – Public hospitals struggling to meet demand and targets as Federal funding declines – 14 February 2014

Posted on February 14, 2014. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: , |

AMA Public Hospital Report Card 2014 – Public hospitals struggling to meet demand and targets as Federal funding declines – 14 February 2014

The AMA Public Hospital Report Card 2014

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Small Ideas for Saving Big Health Care Dollars – RAND – January 2014

Posted on January 31, 2014. Filed under: Health Economics, Health Systems Improvement | Tags: |

Small Ideas for Saving Big Health Care Dollars – RAND – January 2014

“A focused review of recent RAND Health research identified small ideas that could save the U.S. health care system $13 to $22 billion per year, in the aggregate, if successfully implemented. In the substituting lower-cost treatments category, ideas are to reduce use of anesthesia providers in routine gastroenterology procedures for low-risk patients, change payment policy for emergency transport, increase use of lower-cost antibiotics for treatment of acute otitis media, shift care from emergency departments to retail clinics when appropriate, eliminate co-payments for higher-risk patients taking cholesterol-lowering drugs, increase use of $4 generic drugs, and reduce Medicare Part D use of brand-name prescription drugs by patients with diabetes. In the patient safety category, ideas are to prevent three types of health care-associated infections: (1) central line-associated bloodstream infections, (2) ventilator-associated pneumonia, and (3) catheter-associated urinary tract infections; use preoperative and anesthesia checklists to prevent operative and postoperative events; prevent in-facility pressure ulcers; use ultrasound guidance for central line placement; and prevent recurrent falls.

Small ideas do not require systemic change; thus, they may be both more feasible to operationalize and less likely to encounter stiff political and organizational resistance.”

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Productivity of the English National Health Service from 2004/5: updated to 2011/12 – University of York – January 2014

Posted on January 30, 2014. Filed under: Health Economics |

Productivity of the English National Health Service from 2004/5: updated to 2011/12 – University of York – January 2014

Chris Bojke, Adriana Castelli, Katja Grasic, Andrew Street.

Accompanying spreadsheet covering NHS productivity from 2004/5 to 2010/11

Don’t believe the hype, NHS productivity is actually rising – HSJ – 16 January 2014

Exposing the myth of NHS waste boosts case for investment – HSJ – 16 January 2014

 

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Identifying best practices for care-dependent elderly by benchmarking costs and outcomes of community care – iBenC – 10 January 2014

Posted on January 30, 2014. Filed under: Aged Care / Geriatrics, Community Services, Health Economics |

Identifying best practices for care-dependent elderly by benchmarking costs and outcomes of community care – iBenC – 10 January 2014

“Report D6.1: Review on the structure of community care of the six participating countries and their benchmarking practices Van Eenoo, L.; Declercq, A.; Van der Roest, H.; Van Hout, H. – on behalf of the IBenC consortium

The overall aim of IBenC project is to identify best practices in community care delivery for care dependent community dwelling elderly people by benchmarking the cost-effectiveness of community care delivery systems across Europe. To understand why some organisations and health care systems provide better quality of care than others, studying the micro (client), meso (organisation) and macro (policy) levels is equally important. This report focuses on the macro level of care delivery and reviews and compares the context, regulations and conditions for community care system delivery to care dependent elderly in countries that participate in IBenC (Belgium, Finland, Germany, Iceland, Italy and the Netherlands).”

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Examining the effectiveness and cost-effectiveness of rehabilitation-care models for frail seniors – McMaster University Health Forum Issue Brief – 30 September 2013

Posted on January 30, 2014. Filed under: Aged Care / Geriatrics, Health Economics, Rehabilitation |

Examining the effectiveness and cost-effectiveness of rehabilitation-care models for frail seniors – McMaster University Health Forum Issue Brief – 30 September 2013

Wilson MG. Rapid Synthesis: Examining the Effectiveness and Cost-Effectiveness of Rehabilitationcare Models for Frail Seniors. Hamilton, Canada: McMaster Health Forum, 30 September 2013.

Extract from the key messages

“Question
How effective and cost-effective are different models of physical and occupational rehabilitation for frail seniors?

Why the issue is important
Functional difficulties significantly compromise quality of life and are associated with depression, increased frailty, long-term care home (LTCH) placement, and mortality.
Rehabilitation services to improve functional abilities are generally understood to be essential components of the bundle of services that should be made available to seniors to help them live in their own homes for as long as possible.
It has been recommended that Ontario adopt an ‘assess and restore’ approach to the care of all seniors that emphasizes timely access to rehabilitation and other ‘restorative care’ services as a means of avoiding or delaying LTCH placement, emergency department visits, and admissions to hospital.

What we found”

… continues on the site

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Report on Government Services 2014 – Productivity Commission – volume E Health due for publication Thursday 30 January 2014

Posted on January 29, 2014. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

Report on Government Services 2014 – Productivity Commission – volume E – Health due for publication Thursday 30 January 2014

Will cover:

Public hospitals
Primary and community health
Mental health management

Other volumes

Volume A: Approach to performance reporting – 28 January 2014
Volume B: Child care, education and training – 28 January 2014
Volume C: Justice 29 January 2014
Volume D: Emergency Management – 29 January 2014
Volume F: Community services – 31 January 2014
Volume G: Housing and Homelessness – 31 January 2014
Indigenous compendium – due April 2014

 

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Beyond big contracts: commissioning public services for better outcomes – Institute for Government – 23 January 2014

Posted on January 24, 2014. Filed under: Health Economics | Tags: |

Beyond big contracts: commissioning public services for better outcomes – Institute for Government – 23 January 2014

“This report is the output of a joint project between Collaborate and the Institute for Government, supported by the Calouste Gulbenkian Foundation.

It aims to convey the experience of those organisations and workers most closely involved in delivering complex services, such as adult social care, mental health drug and alcohol rehabilitation and special educational needs.

Research involved a series of in-depth interviews, expert workshops and roundtables with commissioners, policy professionals, providers and practitioners of complex services.

Two separate surveys asked participants about how ready organisations were to respond to the government’s public service reform agenda, and how well set up they were for an increasingly complex commissioning environment.”

News release: New Collaborate/IfG report: Beyond Big Contracts

“Beyond big contracts: payment by results harming social sector’s ability to help most vulnerable, new report says

High profile problems with large outsourcing providers have led to government pledges to involve more SMEs and voluntary sector providers in delivering its Open Public Services agenda.

But a new study has found that commissioners and providers may not succeed in the current contracting environment, which some argue is more suited to larger providers and doesn’t necessarily help those most in need.

While it is acknowledged that social sector organisations can often deliver high quality outcomes for users of complex services, such as drug and alcohol rehabilitation, their size makes them more vulnerable to financial risk compared to larger providers. Furthermore, they often lack the necessary commercial and contract management skills to succeed when operating in a ‘payment by results’ (PbR) framework, which can also impair their ability to create the collaborative partnerships required to meet the most complex needs.”

… continues on the site

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Healthcare Associated Infections – litigation and reputation – MindMetre – January 2014

Posted on January 24, 2014. Filed under: Health Economics, Infection Control | Tags: |

Healthcare Associated Infections – litigation and reputation – MindMetre – January 2014

“A MindMetre research note on the reputational risk to healthcare institutions of litigation by patients suing as a result of an HCAI

Health economics studies of return on investment from screening for Healthcare Associated Infections (HCAIs) have tended to focus only on the consequent reduction in patient treatment costs. A few studies have also looked at the direct impact of patient lawsuits resulting from HCAIs, but here only in terms of the cost of damages and legal fees. This short research note suggests that, in the newly structured NHS, where groups of GPs – Clinical Commissioning Groups (CCGs) – are now commissioning acute services, where competition for service provision between trusts is overtly encouraged, and where there is a clear mandate to ‘ improve patient outcomes’, HCAI rates are likely to play an increasing role in the ability of a trust to attract patients and the funds that come with them.”

… continues on the site

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London Mental Health: The invisible costs of mental ill health – 22 January 2014

Posted on January 23, 2014. Filed under: Health Economics, Mental Health Psychi Psychol |

London Mental Health: The invisible costs of mental ill health – 22 January 2014

“Unfortunately, mental ill health remains one of the least understood of all health problems, and stigma stops people from addressing it. It is time London faced up to mental ill health and the effects it has on our community. To that end, the Mayor has developed the report, London Mental Health: The invisible costs of mental ill health.

The report seeks to shed light on the scope and scale of mental ill health in London, to highlight the wider impacts beyond those to health and social care. These wider impacts result in around £26 billion each year in total economic and social costs to London and impact every facet of our community.

Read the report to find out just how much mental illness is affecting London.”

Media release: Action on mental health could help save London up to £26 billion a year

“The scale of mental ill health in London is costing the capital around £26 billion a year, a new report commissioned by the Mayor Boris Johnson has revealed today.

In any given year, an estimated one in four Londoners will experience a diagnosable mental health condition. A third of these will experience two or more conditions at once. According to a Department of Health report, the impact of mental ill health is greater than cancer and cardiovascular disease. It represents around 22.8% of the total, compared to 15.9% and 16.2% respectively.”

… continues on the site

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Multinational Comparisons of Health Systems Data, 2013 – Commonwealth Fund – 17 January 2014

Posted on January 20, 2014. Filed under: Health Economics | Tags: |

Multinational Comparisons of Health Systems Data, 2013 – Commonwealth Fund – 17 January 2014

“Overview

International comparisons of health care systems offer valuable tools to health ministers, policymakers, and academics wishing to evaluate the performance of their country’s system. In this chartbook, we use data collected by the Organization for Economic Cooperation and Development (OECD) to compare health care systems and performance on a range of topics, including spending, hospitals, physicians, pharmaceuticals, prevention, mortality, quality and safety, and prices. We present data across several industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Whenever possible, we also present the median value of all 34 members of the OECD.”

… continues on the site

 

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Capturing Value from Health Technologies in Lean Times – C.D. Howe Institute – 18 December 2013

Posted on January 14, 2014. Filed under: Health Economics, Health Technology Assessment, Pharmacy |

Capturing Value from Health Technologies in Lean Times – C.D. Howe Institute – 18 December 2013

“In budget-constrained times, adopting new drugs or medical technology is a high-stakes challenge that requires a comprehensive, balanced approach, according to a report released today by the C.D. Howe Institute. In “Capturing Value from Health Technologies in Lean Times,” authors Ake Blomqvist, Colin Busby and Don Husereau argue healthcare policymakers should make greater use of Health Technology Assessment (HTA), a policy tool that can help them balance demand and supply pressures for new technologies within a health-system budget.”

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Realizing the Promise of Healthcare Innovation in Ontario – Increasing Value for the Patient, Health System and Economy – Ontario Bioscience Innovation Organization – December 2013

Posted on January 14, 2014. Filed under: Health Economics, Health Technology Assessment, Pharmacy | Tags: |

Realizing the Promise of Healthcare Innovation in Ontario – Increasing Value for the Patient, Health System and Economy – Ontario Bioscience Innovation Organization – December 2013

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Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data – Health Services and Delivery Research – January 2014

Posted on January 10, 2014. Filed under: Health Economics, Orthopaedics, Surgery | Tags: |

Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data – Health Services and Delivery Research – January 2014

DOI 10.3310/hsdr02010 NHS National Institute for Health Research

Street A, Gutacker N, Bojke C, Devlin N, Daidone S. Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data. Health Serv Deliv Res 2014;2(1)

“Background: It is important that NHS resources are used to their full extent, but efforts to reduce costs may have an adverse effect on patient outcomes. Our research is designed to provide a better understanding of the inter-relationship between costs and health outcomes among NHS providers (hospitals) for common surgical procedures.

Objectives: In England, patient-reported outcomes measures (PROMs) are collected from patients undergoing one of four elective procedures: unilateral hip replacement, unilateral knee replacement, groin hernia repair and varicose vein surgery. We identify variation in patient-reported outcomes (PROs) across hospitals, assess the relationship between the cost and outcomes among NHS hospitals for these procedures, and determine the extent to which variations in outcomes and costs are due to differences in hospital performance.

Data sources: We link Hospital Episode Statistics (HES) data with reference cost data and PROM data for patients having the four treatments between April 2009 and March 2010.

Methods: The first part of the empirical analysis focuses on variation in different dimensions of self-reported health status. We argue that each of the EuroQol-5D questionnaire (EQ-5D; European Quality of Life-5 Dimensions) dimensions should be assessed separately. Our graphical summary of the differential impact that hospitals have on PROs indicates the probability of reporting a given health outcome and shows how these probabilities vary across EQ–5D dimensions and hospitals. The second part of the empirical analysis focuses on the performance of hospitals and the inter-relationship between PROs and resource use.

Results: We find that poorer post-treatment health status is associated with lower initial health status, higher weighted Charlson score, more diagnoses and lower socioeconomic status. We find significantly unexplained variation among hospitals in outcomes for patients undergoing hip replacement, knee replacement or varicose vein surgery, but not for hernia patients. For all four treatments we find significant unexplained variation in resource use among hospitals, whether measured by cost of treatment or length of stay. This suggests that hospitals can improve their utilisation of resources.

Limitations: Our analyses are based on the HES. If data are missing from the medical record, or extracted and coded inaccurately, HES will contain errors. Hospitals should minimise these errors. Our study suffers from a large number of missing data, mainly because some hospitals were better than others at administering the baseline survey.”

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Costing seven day services: The financial implications of seven day services for acute emergency and urgent services and supporting diagnostics – Healthcare Financial Management Association (HFMA) – 17 December 2013

Posted on December 24, 2013. Filed under: Acute Care, Diagnostics, Emergency Medicine, Health Economics | Tags: |

Costing seven day services: The financial implications of seven day services for acute emergency and urgent services and supporting diagnostics – Healthcare Financial Management Association (HFMA) – 17 December 2013

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IHE In Your Pocket 2014. A Handbook of Health Economics Statistics – Institute of Health Economics, Alberta Canada – December 2013

Posted on December 17, 2013. Filed under: Health Economics |

IHE In Your Pocket 2014. A Handbook of Health Economics Statistics – Institute of Health Economics, Alberta Canada – December 2013

“IHE In Your Pocket was designed to provide a compact, comprehensive, and comparative overview of the economic aspects of the Canadian health care system. It has been revised every second year since 2006.

As in the earlier editions, we have adopted a broad, population health approach. We have substantially reorganized the 2014 edition. We divided data on the health care system into components. For each component, we provide the most important economic indicators which reflect capacity, investment, utilization, prices and costs, total expenditures and finance, on the supply side; and population characteristics, population behaviour, finance and indirect costs on the demand side.”

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Pricing Framework for Australian Public Hospital Services 2014-15 – Independent Hospital Pricing Authority (IHPA) – 6 November 2013

Posted on December 13, 2013. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: , |

Pricing Framework for Australian Public Hospital Services 2014-15 – Independent Hospital Pricing Authority (IHPA) – 6 November 2013

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Osteoporosis costing all Australians: a new burden of disease analysis: 2012 to 2022 – Osteoporosis Australia – December 2013

Posted on December 11, 2013. Filed under: Chronic Disease Mgmt, Health Economics, Orthopaedics |

Osteoporosis costing all Australians: a new burden of disease analysis: 2012 to 2022 – Osteoporosis Australia – December 2013

“This report updates previous burden of disease analysis undertaken in 2001 and 2007, and shows little progress is being made in preventing and managing osteoporosis in Australia. With an ageing population, it is now critical that real steps are taken to address this silent and often underdiagnosed disease affecting women and men that is costing governments, the community and comes at a great personal cost to the individuals affected.

The new information in this report on the current and future costs of osteoporosis in Australia will aid government policy makers, funding bodies, clinicians, researchers and health care organisations in assessing the importance of reducing osteoporosis and osteoporosis – related fractures, promoting bone health and in identifying future resource needs.”

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The influence of cost-effectiveness and other factors on NICE decisions – Centre for Health Economics, University of York – November 2013

Posted on December 10, 2013. Filed under: Evidence Based Practice, Health Economics, Health Mgmt Policy Planning, Health Policy | Tags: , |

The influence of cost-effectiveness and other factors on NICE decisions – Centre for Health Economics, University of York – November 2013

“Abstract

Background: The National Institute for Health and Care Excellence (NICE) emphasises that costeffectiveness is not the only consideration in health technology appraisal and is increasingly explicit about other factors considered relevant. Observing NICE decisions and the evidence considered in each appraisal allows us to ‘reveal’ its implicit weights.

Objectives: This study aims to investigate the influence of cost-effectiveness and other factors on NICE decisions and to investigate whether NICE’s decision-making has changed through time.

Methods: We build on and extend the modelling approaches in Devlin and Parkin (2004) and Dakin et al (2006). We model NICE’s decisions as binary choices: i.e. recommendations for or against use of a healthcare technology in a specific patient group. Independent variables comprised: the clinical and economic evidence regarding that technology; the characteristics of the patients, disease or treatment; and contextual factors affecting the conduct of health technology appraisal. Data on all NICE decisions published by December 2011 were obtained from HTAinSite [www.htainsite.com].

Results: Cost-effectiveness alone correctly predicted 82% of decisions; few other variables were significant and alternative model specifications led to very small variations in model performance. The odds of a positive NICE recommendation differed significantly between musculoskeletal disease, respiratory disease, cancer and other conditions. The accuracy with which the model predicted NICE recommendations was slightly improved by allowing for end of life criteria, uncertainty, publication date, clinical evidence, only treatment, paediatric population, patient group evidence, appraisal process, orphan status, innovation and use of probabilistic sensitivity analysis, although these variables were not statistically significant. Although there was a non-significant trend towards more recent decisions having a higher chance of a positive recommendation, there is currently no evidence that the threshold has changed over time. The model with highest prediction accuracy suggested that a technology costing £40,000 per quality-adjusted life-year (QALY) would have a 50% chance of NICE rejection (75% at £52,000/QALY; 25% at £27,000/QALY).

Discussion: Past NICE decisions appear to have been based on a higher threshold than the £20,000 – £30,000/QALY range that is explicitly stated. However, this finding may reflect consideration of other factors that drive a small number of NICE decisions or cannot be easily quantified.”

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Reassessing existing funded health services and products to support appropriate care – Canadian Foundation for Healthcare Improvement – 29 November 2013

Posted on December 4, 2013. Filed under: Health Economics, Health Mgmt Policy Planning, Health Policy, Health Systems Improvement | Tags: |

Reassessing existing funded health services and products to support appropriate care – Canadian Foundation for Healthcare Improvement – 29 November 2013

“In Ontario, new healthcare services and technologies coming into the system must undergo a rigorous evidence-based assessment. But what about existing services and technologies that are already in use? Which of those should be subjected to new evidence-based analyses to determine if they add value and are appropriate? Without a framework to identify priorities for reassessment from the thousands of existing funded services and products, the prospect of determining which services to scale back, focus or discontinue would be problematic at best.”

 

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Promoting health, preventing disease: is there an economic case? – European Observatory on Health Systems and Policies – 2013

Posted on December 4, 2013. Filed under: Health Economics, Public Hlth & Hlth Promotion | Tags: |

Promoting health, preventing disease: is there an economic case? – European Observatory on Health Systems and Policies – 2013

“Executive summary

A core question for policy-makers will be the extent to which investments in preventive actions that address some of the social determinants of health represent an effi cient option to help promote and protect population health. Can they reduce the level of ill health in the population? How strong is the evidence base on their effectiveness and, from an economic perspective, how do they stack up against investment in the treatment of health problems? Are there potential gains to be made by reducing or delaying the need for the consumption of future health care resources? Will they limit some of the wider costs of poor health to society, such as absenteeism from work, poorer levels of educational attainment, higher rates of violence and crime and early retirement from the labour force due to sickness and disability?

This policy summary provides an overview of what is known about the economic case for investing in a number of different areas of health promotion and non-communicable disease prevention. It focuses predominantly on addressing some of the risk factors for health: tobacco and alcohol consumption, impacts of dietary behaviour and patterns of physical activity, exposure to environmental harm, risks to mental health and well-being, as well as risks of injury on our roads.

It highlights that there is an evidence base from controlled trials and welldesigned observational studies on the effectiveness of a wide range of health promotion and disease prevention interventions that address risk factors to health. Moreover, the cost–effectiveness of a number of health promotion and disease prevention interventions has been shown in multiple studies. Some of these interventions will be cost-saving, but most will generate additional health (and other) benefits for additional costs. ”

… continues

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Poor pricing progress: price disclosure isn’t the answer to high drug prices – Grattan Institute – 1 December 2013

Posted on December 3, 2013. Filed under: Health Economics, Pharmacy | Tags: |

Poor pricing progress: price disclosure isn’t the answer to high drug prices – Grattan Institute – 1 December 2013

“While the wholesale price of seven medicines fell by about a third today, Australia has a long way to go before consumers pay fair prices for pharmaceuticals.

Even after today’s reductions, Australian prices for the seven drugs are on average 14 times higher than prices for the same medicines in the United Kingdom.

Australia’s “price disclosure” policy was introduced in 2007 in a bid to cut costs. But drugs that have just been through this process have wholesale prices that are on average over 16 times the lowest price in New Zealand, the UK and the Canadian province of Ontario.

Under price disclosure, pharmacies are forced to reveal discounts on drug prices that manufacturers provide them, and the Government accordingly reduces the amount paid to pharmacies for each drug.

But Grattan Institute’s earlier report, Australia’s bad drug deal, revealed that if the Government benchmarked the prices of generic drugs against prices paid overseas it could save more than $1 billion a year in payments to manufacturers.

The Government’s purchasing policy needs to be much tougher on manufacturers and much fairer for consumers. It is not just a matter of saving money: nearly one in 10 Australians doesn’t take medicines a doctor prescribes because of cost.

For six of the seven drugs with price cuts today, benchmarking would save patients nearly $20 more for each box of pills, on average.”

… continues on the site

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International Profiles of Health Care Systems, 2013 – The Commonwealth Fund – 14 November 2013

Posted on November 27, 2013. Filed under: Evidence Based Practice, Health Economics, Health Informatics, Health Mgmt Policy Planning, Health Policy | Tags: |

International Profiles of Health Care Systems, 2013 – The Commonwealth Fund – 14 November 2013

S. Thomson, R. Osborn, D. Squires, and M. Jun, International Profiles of Health Care Systems, 2013, The Commonwealth Fund, November 2013.

“This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.”

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Money well spent? Assessing the cost effectiveness and return on investment of public health interventions – Local Government Association [UK] – November 2013

Posted on November 19, 2013. Filed under: Health Economics, Public Hlth & Hlth Promotion | Tags: , , |

Money well spent? Assessing the cost effectiveness and return on investment of public health interventions – Local Government Association [UK] – November 2013

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Effective Clinical and Financial Engagement: A best practice guide for the NHS – November 2013

Posted on November 19, 2013. Filed under: Health Economics |

Effective Clinical and Financial Engagement: A best practice guide for the NHS – November 2013

Extract from the foreword

“Across England, NHS organisations are facing the challenge of delivering their commitments under the NHS Outcomes Framework within current financial constraints.

Finance managers have a critical role to play in this challenge but they cannot deliver it alone. It is clinicians – doctors, nurses and allied health professionals – who commit NHS resources and who need a greater understanding of the financial consequences of their actions.

In this context, many questions have been raised in the NHS. Not least, what do clinical and financial professionals need to be able to develop more productive partnerships? What are the barriers which the NHS needs to overcome, the key levers for engagement and the best practice steps for a way forward?

This best practice guide has been developed to answer these questions and to help promote and create engagement on a large scale between clinicians and finance professionals. It aims to help NHS organisations to seize the opportunity provided by the current financial challenges to develop new partnerships between their clinical and finance teams which are capable of cocreating added value.”

… continues

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Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis – NHS National Institute for Health Research – November 2013

Posted on November 7, 2013. Filed under: Chronic Disease Mgmt, Health Economics | Tags: , , |

Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis – NHS National Institute for Health Research – November 2013

Lewis GH, Georghiou T, Steventon A, Vaithianathan R, Chitnis X, et al. Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis. Final report. NIHR Service Delivery and Organisation programme; 2013.

Extract from the executive summary

“Background
Health care systems in many developed countries are currently under financial strain because of ageing populations, the rising prevalence of various chronic diseases, and budgetary constraints resulting from the global economic downturn.

The costs of providing health care are highly skewed across the population, with a small number of patients accounting for a large proportion of expenditure. Since unplanned hospital admissions account for a high proportion of costs, considerable resources could potentially be invested in providing preventive care for a relatively small number of costly patients and yet still potentially yield net savings overall from averted future hospital costs. In practice, however, such savings have been difficult or impossible to demonstrate.

One reason why preventive interventions may be unsuccessful at reducing demand is if they are offered to patients who are at insufficiently high risk of future unplanned hospital admission. In 2005, the Department of Health commissioned two “case finding” tools for improving the identification of high-risk patients in England. Known as “PARR” and the “Combined Model”, these predictive risk tools are now used in many parts of the country to select which high-risk patients should be offered a hospital-avoidance intervention.

One such intervention is the “virtual ward”. This model of care uses the staffing, systems and daily routines of a hospital ward to deliver preventive care to patients in their own homes in the aim of mitigating their risk of unplanned hospitalisation. Whilst virtual wards have been introduced in many parts of the UK and overseas, their efficacy and cost-effectiveness has yet to be determined.”

… continues

Related Article from the International Journal of Integrated Care

Integrating care for high-risk patients in England using the virtual ward model: lessons in the process of care integration from three case sites – November 2013

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Clinical ICT Systems in the Victorian Public Health Sector – Auditor General – 30 October 2013

Posted on November 5, 2013. Filed under: Health Economics, Health Informatics |

Clinical ICT Systems in the Victorian Public Health Sector – Auditor General – 30 October 2013

“Under the provisions of section 16AB of the Audit Act 1994, I transmit my report on the audit Clinical ICT Systems in the Victorian Public Health Sector.

This audit reviewed clinical ICT systems in eight Victorian public health services and examined whether they have been appropriately planned and implemented and whether expected outcomes and benefits are being realised.

I found that poor planning and inadequate understanding of the complex requirements of designing and implementing clinical ICT systems meant that the Department of Health has delivered the HealthSMART clinical ICT system to only four Victorian health services and at a cost of $145.3 million. Some clinical ICT systems have issues that potentially affect patient safety and need to be closely monitored and resolved by the department and relevant health services.

Outside the HealthSMART program, other clinical ICT systems that have been incrementally developed with strong clinician engagement enjoy wide acceptance and support from end users. Although their functionality is not directly equivalent to the HealthSMART system, these other systems have involved significantly less capital and ongoing expenditure.”

Victorian Auditor-General slams HealthSmart implementation – Pulst+IT – 1 November 2013

Victoria abandons health IT centralisation – Pulst+IT – 29 October 2013

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An Introduction to the Ethical Implications of Economic Evaluations for Healthy Public Policy – National Collaborating Centre for Healthy Public Policy [Canada] – October 2013

Posted on October 24, 2013. Filed under: Health Economics, Public Hlth & Hlth Promotion | Tags: , |

An Introduction to the Ethical Implications of Economic Evaluations for Healthy Public Policy – National Collaborating Centre for Healthy Public Policy [Canada] – October 2013

“This briefing note is the first in a series that introduces a critical analysis of the ethical implications of economic evaluations, especially as they arise in the context of healthy public policy. It begins by introducing the main types of economic evaluation (cost-benefit, cost-effectiveness, and cost-utility), their general strengths and weaknesses, and what they aim to measure through different means: efficiency…..

It moves on to examine the ethical implications of the ethical (utilitarianism) and methodological (individualism) assumptions shared by the main types of economic evaluations. It concludes by exploring the ways in which economic evaluations can be read and interpreted so that values relevant for public health, which can conflict with those implicitly put forward by economic evaluations, do not fall out of the view of policy makers.”

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Environmental health and economics: use of economic tools and methods in environmental health – WHO – 23 October 2013

Posted on October 24, 2013. Filed under: Environmental Health, Health Economics | Tags: |

Environmental health and economics: use of economic tools and methods in environmental health – WHO – 23 October 2013

Media release: Visualizing the economic and health benefits of environmental measures: a winning combination

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Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults: Workshop Summary – Institute of Medicine – 2013

Posted on October 23, 2013. Filed under: Chronic Disease Mgmt, Health Economics | Tags: , |

Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults: Workshop Summary – Institute of Medicine – 2013

ISBN 978-0-309-29406-5

“Description

Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults is the summary of a workshop convened in June 2013 by the Forum on Aging, Disability, and Independence of the Institute of Medicine and the National Research Council to examine the financing of long-term services and supports for working-age individuals with disabilities and among individuals who are developing disabilities as they age. The workshop covered both older adults who acquire disabilities and younger adults with disabilities who may acquire additional impairments as they age, the target population of the Forum’s work. The challenges associated with financing long-term services and supports for people with disabilities impacts all age groups. While there are important differences between the characteristics of programs developed for different age groups, and specific populations may have different needs, this workshop addressed the financing sources for long-term services and supports in general, noting specific differences as appropriate.

The financing of long-term services and supports has become a major issue in the United States. These are the services and supports that individuals with disabilities, chronic conditions, and functional impairments need in order to live independently, such as assistance with eating, bathing, and dressing. Long-term services and supports do not include the medical or nursing services required to manage health conditions that may be responsible for a disabling condition. At least 11 million adults ages 18 and over receive long-term services and supports. Only a little more than half of them – 57 percent – are ages 65 or older. One study found that about 6 percent of people turning 65 in 2005 could expect to have expenses of more than $100,000 for long-term services and supports. Financing Long-Term Services and Supports for Individuals with Disabilities and Older Adults discusses the scope and trends of current sources of financing for long-term services and supports for working-age individuals with disabilities and older adults aging into disability, including income supports and personal savings. This report considers the role of families, business, and government in financing long-term services and supports and discusses implications of and opportunities for current and innovative approaches.”

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Managing financial difficulties in health economies: lessons for clinical commissioning groups – Nuffield Trust – 17 October 2013

Posted on October 17, 2013. Filed under: Health Economics | Tags: |

Managing financial difficulties in health economies: lessons for clinical commissioning groups – Nuffield Trust – 17 October 2013

This report examines why some health economies have been more successful than others in balancing their finances and outlines some key lessons for clinical commissioning groups.”

 

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Closing the NHS funding gap: how to get better value health care for patients – Monitor – 10 October 2013

Posted on October 14, 2013. Filed under: Health Economics | Tags: |

Closing the NHS funding gap: how to get better value health care for patients – Monitor – 10 October 2013

“To fulfil its constitution, the NHS must continue to provide a comprehensive, excellent service, available to all. But trends in funding and demand will create a sizeable funding gap.

Recent projections from the Nuffield Trust and NHS England suggest this gap could grow to £30 billion a year by 2021. The gap could be smaller if the economy as a whole expands faster than expected. But commissioners and providers cannot rely on this happening. In short, the sector faces its greatest financial challenge of recent times over the next eight years or so.

To meet this challenge, health services must change fundamentally or the quality of care that patients receive will fall.
Opportunities to close the gap

Improving productivity within existing services;
Delivering the right care in the right settings, including increasing care in the community;
Developing new, innovative ways of delivering care;
Making ‘one-off’ reductions in capital expenditure and staffing costs; and
Changing the way health spending is allocated which is currently based on historic demand.

These opportunities won’t be easily achieved, but have the potential to close the financial gap and improve the way services are delivered.”

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Universal Health Coverage: Why health insurance schemes are leaving the poor behind – Oxfam – 9 October 2013

Posted on October 14, 2013. Filed under: Health Economics | Tags: |

Universal Health Coverage: Why health insurance schemes are leaving the poor behind – Oxfam – 9 October 2013

ISBN 978-1-78077-480-0

“Universal Health Coverage is about the right to health. Everyone – rich or poor – should get the health care they need without suffering financial hardship. Unfortunately, some donors and developing country governments are promoting health insurance schemes that exclude the majority of people and l may also reinforce inequality – by prioritizing people who are formally employed and excluding the most poor and marginalized who cannot afford to pay premiums, especially women.

However, a number of developing countries are rejecting this model and prioritizing general government spending for health to successfully scale up health coverage. Funding through progressive taxation and international aid is the key to achieving Universal Health Coverage. Oxfam estimates that improving tax collection in 52 developing countries could raise an additional $269bn – enough to double health budgets in these countries.

This paper explains why urgent action on global tax evasion and avoidance is needed to ensure that countries can generate and retain more of their own resources for health. Donors and governments should abandon unworkable insurance schemes and focus on financing that delivers universal and equitable health care for all.”

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Acting Early, Changing Lives: How prevention and early action saves money and improves wellbeing – Benevolent Society – October 2013

Posted on October 10, 2013. Filed under: Child Health / Paediatrics, Health Economics | Tags: , |

Acting Early, Changing Lives: How prevention and early action saves money and improves wellbeing – Benevolent Society – October 2013

Written for The Benevolent Society by The Centre for Community Child Health at the Murdoch Children’s Research
Institute and The Royal Children’s Hospital, Melbourne.
ISBN: 978-0-9922982-5-8

Extract from the executive summary:

“Evidence indicates worsening or unacceptably high levels of problems amongst Australia’s children and young people. These problems will not improve – and could get worse – unless we are able to effectively intervene to prevent these problems from occurring in the first place or address the problems early before they become entrenched.

This report investigates the potential of early intervention to improve the outcomes of Australian children, especially those children experiencing significant levels of disadvantage, and especially for the long-term (i.e. into adolescence and adulthood).

Early intervention is defined in this report as interventions that occur during the early years of an individual’s life (0-5 years of age) in order to prevent a negative outcome or to address an existing problem.

The justification for early intervention (i.e. intervention during the early years) rests with the nature of human
development and the way in which children develop and learn. The basic foundations for development are laid
down during the early childhood years. The prenatal period also plays an important role in an individual’s longterm outcomes.”

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Chronic disease management: the role of private health insurance – Parliament of Australia – 4 October 2013

Posted on October 4, 2013. Filed under: Chronic Disease Mgmt, Health Economics | Tags: |

Chronic disease management: the role of private health insurance – Parliament of Australia – 4 October 2013

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The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance – Harvard Business School – 27 September 2013

Posted on October 1, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics, Patient Participation |

The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance – Harvard Business School – 27 September 2013

by Claire Senot, Aravind Chandrasekaran, Peter T. Ward, and Anita L. Tucker

“Executive summary.  This study examines the relationship between hospital’s focus on both conformance and experiential dimensions of quality and their impact on financial and clinical outcomes. Conformance quality measures the level of adherence to evidence-based standards of care achieved by the hospitals. Experiential quality, on the other hand, measures the extent to which caregivers consider the specific needs of the patient in care and communication, as perceived by the patient. These are important dimensions to investigate because hospitals may face a tension between improving clinical outcomes and maintaining their financial bottom-line. However, little has been known on the joint impact of these dimensions on hospital performance in terms of cost and clinical quality. The authors’ study, which examined data from multiple sources for the 3,458 U.S. acute care hospitals, is a first step towards understanding these relationships.”

… continues on the site

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Our Health, Our Community – Consumers Health Forum of Australia – Drugged by reality – losing $2,000 a minute and counting

Posted on September 24, 2013. Filed under: Health Economics, Pharmacy | Tags: |

Our Health, Our Community – Consumers Health Forum of Australia – Drugged by reality – losing $2,000 a minute and counting 

The Consumers Health Forum has just launched a website containing information about the cost of generic drugs in Australia compared to other countries. Each day, Australians pay $3 million dollars more for these drugs than they would if they bought them in NZ or the UK. Unless the policy is changed, that $3 million will add up to $1 billion in lost savings by this time next year.

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Sustainability of the Canadian Health Care System and Impact of the 2014 Revision to the Canada Health Transfer – Canadian Institute of Actuaries – September 2013

Posted on September 20, 2013. Filed under: Health Economics | Tags: |

Sustainability of the Canadian Health Care System and Impact of the 2014 Revision to the Canada Health Transfer – Canadian Institute of Actuaries – September 2013

“The cost of the Canadian health care system has been increasing steadily with health care expenditures of provinces and territories over the last five years outpacing the annual rate of inflation by nearly 4 percent. The question of how to fund and even contain growing health care costs is the topic of significant discussion and debate in Canada. While Canadian provinces and territories are predominantly responsible for their own health care delivery, the federal government provides funding support through the Canada Health Transfer (CHT). The objective of this report is to estimate the future costs of the Canadian health care system, assess the sustainability of the system over a 25-year horizon, and analyze the implications of the changes to the CHT proposed on Dec. 19, 2011 by the federal government.”

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Better health, better care, better value for all: Refocusing health care reform in Canada – Health Council of Canada – September 2013

Posted on September 20, 2013. Filed under: Health Economics, Health Mgmt Policy Planning, Health Systems Improvement | Tags: |

Better health, better care, better value for all: Refocusing health care reform in Canada – Health Council of Canada – September 2013

“This report looks back on the last decade of health care reform, identifies what worked and what didn’t, and recommends a
better path to achieving a high-performing health system for Canada into the future.”

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The dismantled National Programme for IT in the NHS – House of Commons Committee of Public Accounts – report – published 18 September 2013

Posted on September 19, 2013. Filed under: Health Economics, Health Informatics | Tags: |

The dismantled National Programme for IT in the NHS – House of Commons Committee of Public Accounts – report – published 18 September 2013

Summary

“Although the National Programme for IT in the NHS (the National Programme) has been dismantled, it in effect remains in place with separate component programmes which continue to incur significant costs. The Department of Health (the Department) has been negotiating with CSC for around two years to re-set the contract to provide the Lorenzo care records system to trusts in the North, Midlands and East of England. Its negotiating position is weak. The Department’s statement on the benefits expected from the National Programme showed that most of the benefits are yet to be delivered. There is a risk that some of these benefits may never materialise. Unless the Department acts on the lessons of the failed National Programme it is unlikely to deliver the new vision of a paperless NHS by 2018.”

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Attributing a monetary value to patients’ time: A contingent valuation approach – Centre for Health Economics, University of York, UK – September 2013

Posted on September 12, 2013. Filed under: Health Economics, Patient Participation | Tags: |

Attributing a monetary value to patients’ time: A contingent valuation approach – Centre for Health Economics, University of York, UK – September 2013

“Abstract

It is hard to ignore the importance of patient time investment in the production of health since the influential paper by Grossman (1972). Patient time includes time to admission, travel time, waiting time, and treatment time and can be substantial. Time to admission is the time between the first referral and the moment that the treatment actually starts. Travel time is the time that a patient needs to travel between the place where the patient lives and the medical care centre where the patient is treated. Waiting time is the time that the patient waits at the medical care centre before treatment. Treatment time is the time spent getting active treatment for example by a doctor or a nurse. Patient time is, however, often ignored in economic analyses. This may lead to biased results and inappropriate policy recommendations, which may eventually influence patients’ health, wellbeing and welfare.

How to value patient time is not straightforward. It is even less straightforward for patients who are not participating in the labour market. Although there is some emerging literature on the monetary valuation of patient time, an important challenge remains to develop an approach that can be used to monetarily value time of patients not participating in the labour market. We aim to contribute to the health economics literature by describing and empirically illustrating how to monetarily value patients’ time comprehensively, using the contingent valuation method. Comprehensively means including various types of patient time (time to admission, travel time, waiting time, and treatment time) as the previous literature focused mainly on valuing a particular type of patient time, for instance waiting time.

This paper describes the development of the contingent valuation survey. The survey is added as an appendix to this paper. This paper also presents the first empirical results of applying our survey approach in a sample of patients in the Netherlands not participating in the labour market. These results show that the monetary value of waiting time was the highest (€30.10/£34.76 per hour) and travel and treatment time were equally valued (respectively €13.20/£11.43 and €13.32/£11.54 per hour).”

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Future payment systems in the NHS – Healthcare Financial Management Association (HFMA) – 28 August 2013

Posted on August 30, 2013. Filed under: Health Economics | Tags: , |

Future payment systems in the NHS – Healthcare Financial Management Association (HFMA) – 28 August 2013

Extract

“The Healthcare Financial Management Association (HFMA), in conjunction with The King’s Fund and Monitor, held a one-day workshop for NHS finance leaders in May 2013 to debate a future NHS payment system. The future of the system is critical to support the NHS in transforming services and improving their quality, while at the same time managing within tight financial constraints.

The workshop brought together finance leaders from NHS organisations across the acute, specialist, mental health, community and ambulance sectors, as well commissioners, Monitor and the Department of Health. Participants considered the important design features of a new payment system and how it could be made to work in practice.”

… continues

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Expenditure on health for Aboriginal and Torres Strait Islander people 2010-11: an analysis by remoteness and disease – Australian Institute of Health and Welfare – 23 August 2013

Posted on August 30, 2013. Filed under: Aboriginal TI Health, Health Economics | Tags: |

Expenditure on health for Aboriginal and Torres Strait Islander people 2010-11: an analysis by remoteness and disease – Australian Institute of Health and Welfare – 23 August 2013

“This report provides a detailed analysis of health expenditure for Indigenous and non-Indigenous Australians in 2010-11. Estimates are disaggregated at the regional level, as well as for specific disease and injury groups. For selected services, expenditure increased with remoteness for both Indigenous and non-Indigenous Australians. The disease groups that accounted for the highest proportion of admitted patient expenditure for Aboriginal and Torres Strait Islander people were genitourinary diseases ($195 million or 11% of Indigenous admitted patient expenditure), which includes the cost of dialysis treatment.”

ISSN 13235850; ISBN 9781742494739; Cat. no. HWE 58; 32pp.

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Personal health budgets: challenges for commissioners and policy-makers – Nuffield Trust – August 2013

Posted on August 29, 2013. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: , |

Personal health budgets: challenges for commissioners and policy-makers – Nuffield Trust – August 2013

“A personal health budget is an allocation of NHS money to someone with an identified health need so that they can buy the services they think will improve certain aspects of their health and wellbeing. It is intended to give the recipient more control over the care that they receive.

In 2009 the Department of Health launched a pilot programme to look at the viability of personal health budgets and an independent evaluation was carried out. It was found that they have a positive impact on care-related quality of life and wellbeing and are cost-effective. It was recommended that they should have a wider roll-out. The Government has since committed that from April 2014 everyone who receives NHS continuing health care funding will have a right to request a personal health budget rather than receiving commissioned services. This will present issues and challenges for commissioners and policy-makers.

In this research summary we describe what personal health budgets are and how they are supposed to work in practice. We also look at the evidence from the national evaluation and explore some of the issues that will be raised for commissioners and policy-makers as personal health budgets are rolled out.”

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The World Health Report 2013: Research for Universal Health Coverage – WHO – 15 August 2013

Posted on August 19, 2013. Filed under: Health Economics, Health Status, Public Hlth & Hlth Promotion | Tags: |

The World Health Report 2013: Research for Universal Health Coverage – WHO – 15 August 2013

pdf of the full report

Press release

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Public involvement in decision making relating to potential: Technologies scoping report 16 – Healthcare Improvement Scotland – 17 July 2013

Posted on August 2, 2013. Filed under: Health Economics, Health Technology Assessment, Patient Participation | Tags: |

Public involvement in decision making relating to potential: Technologies scoping report 16 – Healthcare Improvement Scotland – 17 July 2013

“What approaches have been taken and efforts made to ensure public involvement in decision making relating to potential disinvestment in healthcare interventions and technologies?

In response to an enquiry from the Scottish Health Council, Healthcare Improvement Scotland

The following question was scoped:
1. What approaches have been taken and efforts made to ensure public involvement in decision making relating to potential disinvestment in healthcare interventions and technologies?”

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Is it possible to incorporate quality into hospital pricing systems? – Deeble Institute Evidence Brief – 22 July 2013

Posted on July 25, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics | Tags: , |

Is it possible to incorporate quality into hospital pricing systems? – Deeble Institute Evidence Brief – 22 July 2013

“Australia has recently implemented an activity-based funding system for public hospitals. Policymakers and providers are keen to ensure that the price paid for health care services stimulates improvements in quality and safety, but some remain sceptical that this can be achieved through pricing mechanisms.

There are four main ways of linking quality and safety to hospital pricing in the context of activity based funding:”

… continues

 

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Right of private practice in Queensland public hospitals – Queensland Auditor General – 11 July 2013

Posted on July 12, 2013. Filed under: Health Economics |

Right of private practice in Queensland public hospitals – Queensland Auditor General – 11 July 2013

“At the core of the right of private practice scheme is the ability of senior medical officers employed in the public health system to treat patients who come into the public system and elect to be treated as private patients.

This facilitates patient choice, an underlying principle embedded in the Australian Government’s National Health Reform Agreement with the states and territories. The fees charged for these services flow into the public health system.

This interim report is the first of two reports dealing with our performance audit of the right of private practice arrangements in the public health system. This report examines whether the intended health and financial benefits of the scheme are being realised and whether the arrangements are being administered efficiently.”

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The fiscal, social and economic dividends of feeling better and living longer – University of Calgary – June 2013

Posted on June 24, 2013. Filed under: Health Economics, Preventive Healthcare, Public Hlth & Hlth Promotion |

The fiscal, social and economic dividends of feeling better and living longer – University of Calgary – June 2013

“SUMMARY

While Canada has socialized most of the costs of treating illness, Canada has maintained a reliance on individuals interacting through private markets to invest in upstream health promotion and disease prevention. The failure of the market to provide the efficient level of upstream investment in health is leading to large and avoidable increases in the need for downstream medical treatment. The way to reduce the future deadweight loss of illness and disease is for provincial governments to address the upstream market failures through an expansion of the scope of public payment for health care to include upstream services for health promotion and disease prevention. Perhaps somewhat counterintuitively, spending public health-care dollars across a broader range of health and wellness services can result in spending less in total, because of the efficiency gains that will come from better health in the population.

That is certainly what the evidence from a unique Albertan pilot project leads us to conclude. The Pure North S’Energy Foundation is a philanthropic initiative that pays for and provides preventative health-care services for Albertans drawn from groups that are vulnerable to poor health. This includes homeless people, people suffering from addiction, people with low incomes, people in isolated areas and susceptible seniors. The health improvements observed in those participating in the Pure North program have been significant.”

… continues

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Public payment and private provision: the changing landscape of health care in the 2000s – Nuffield Trust – 22 May 2013

Posted on May 31, 2013. Filed under: Health Economics | Tags: |

Public payment and private provision: the changing landscape of health care in the 2000s – Nuffield Trust – 22 May 2013

“A report from the Institute for Fiscal Studies and the Nuffield Trust examining the changing relationship between the public and private sector in the provision of NHS funded care in the past decade.”

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SPend and Outcome Factsheets and Tool (SPOT) – Public Health England

Posted on May 21, 2013. Filed under: Health Economics, Public Hlth & Hlth Promotion | Tags: , , |

SPend and Outcome Factsheets and Tool (SPOT) – Public Health England

“About SPOT

NHS England has commissioned Public Health England to develop a tool which helps commissioners to link health outcomes and expenditure. The development of this tool and a Spend and Outcome Factsheet for every PCT and CCG in England has been led by PHE Knowledge and intelligence team (Northern and Yorkshire)’s Health Economics work programme.

Programme budgeting is a well-established technique for assessing investment in programmes of care rather than services. All PCTs in England have submitted an annual programme budgeting return since 2003/4. The tool and factsheets use this Programme Budgeting data and overall indicators of health outcome by programme (where available) to present PCTs and CCGs with an analysis of the impact of their expenditure. This allows easy identification of those areas which require priority attention, where relative potential shifts in investment opportunities will optimise local health gains and increase quality.

Commissioners can use the tool and the factsheets to gain an overview of outcome and expenditure across all programmes.”

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Lifetime Distributional Effects of Publicly Financed Health Care in Canada – Canadian Institute for Health Information – 14 May 2013

Posted on May 15, 2013. Filed under: Health Economics | Tags: , , |

Lifetime Distributional Effects of Publicly Financed Health Care in Canada – Canadian Institute for Health Information – 14 May 2013

“Public funding of health care has a redistributive effect on the incomes of Canadians, but this is reduced when a life course perspective is considered, according to a new report from the Canadian Institute for Health Information (CIHI).

Lifetime Distributional Effects of Publicly Financed Health Care in Canada looks at estimated lifetime per capita health care costs in the public sector—including doctors, hospitals and some drugs—as well as the portion of household taxes that would be required to pay for these services.

The analysis found that average lifetime health care costs are $237,500 for Canadians in the lowest-income group and $206,000 for Canadians with the highest incomes. However, the difference is much larger when looking at only a single year (2011).

Similarly, while tax payments to finance health care are higher for more-affluent Canadians, differences between income groups are muted when examining costs over a lifetime, rather than in one specific year. The most-affluent Canadians contribute the equivalent of 8% of their average annual income toward publicly funded health care, and the least-affluent contribute 6% of theirs.

The report provides insight into what affluence and poverty would look like in Canada without the existence of publicly financed health care. For example, health care costs for members of the highest-income group are equivalent to 3% of their average income; however, costs for those in the lowest-income group are equivalent to 24% of their average income.”

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Best Care at Lower Cost: The Path to Continuously Learning Health Care in America – Committee on the Learning Health Care System in America, Institute of Medicine – 2013

Posted on May 14, 2013. Filed under: Evidence Based Practice, Health Economics, Health Informatics, Health Mgmt Policy Planning | Tags: , |

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America – Committee on the Learning Health Care System in America, Institute of Medicine – 2013

ISBN-10: 0-309-26073-6    ISBN-13: 978-0-309-26073-2

“America’s health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation’s economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.

The costs of the system’s current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009–roughly $750 billion–was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.

About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.

This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.”

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