HOW DO WE MEASURE EFFICIENCY IN BELGIUM HSPA REPORT 1 P.Meeus MD, MPH,MHA,...

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HOW DO WE MEASURE EFFICIENCY IN BELGIUM HSPA REPORT

P.Meeus MD, MPH,MHA,

Pascal.meeus@inami.fgov.be

OECD 23/10/2014

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1. Introduction

2. Efficiency indicators within Be HSPA

3. Other (in) efficiency indicators within Be HSPA ?

4. Discussion

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1. Introduction

2. Efficiency indicators within Be HSPA

3. Other (in) efficiency indicators within Be HSPA ?

4. Discussion

(Financial) Sustainability

Quality (Financial) Accessibility

Health system objectives

Equitable system ? Efficiency ?

Conceptual model (be)

5 Quality = appropriateness, safety, efficacy, continuity, patient centerdness

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Dimensions

Criteria for indicators

74 (120) indicators

International indicators

Literature screening

60 external experts

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Base for international benchmark: EU-15

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1. Introduction

2. Efficiency indicators within Be HSPA

3. Other (in)efficiency indicators within Be HSPA

4. Discussion

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HSPA Belgium: list of indicators: Efficiency

Indicator Global

Belgium

year Trend over time

Flanders Wal lonia Brussels

Surgica l day,case (%) (2008) 46.2 2008

Surgica l day,case (%) (2010) 47.7 2010 increase 49.9 42.3 49.7

Average length of stay fornormal del ivery (days) (2008)

4.3 2008Average length of stay fornormal del ivery (days) (2010) 4.1 2010 Decrease 4.1 4.2 3.9

Prescription of ambulatory low-cost medications (% DDD ontota l ) (2008)

40,8 2008

Prescription of ambulatory low-cost medications (% DDD on

46.0 2010 46.2 45.9 45.3Prescription of ambulatory low-cost medications (% DDD on 52,8 2012 increase 53,2 52,3 51,6

Share of organised programmfor breast cancer (2008)

51,0 2011

Share of organised programmfor breast cancer (2011) 51.8 2011 increase 72.4 14.0 23.0

Other indicators discussed inthe appropriateness section

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HSPA Belgium: list of indicators: Efficiency

Indicator Global

Belgium

year Trend over time

Flanders Wal lonia Brussels

Surgica l day,case (%) (2008) 46.2 2008

Surgica l day,case (%) (2010) 47.7 2010 increase 49.9 42.3 49.7

Average length of stay fornormal del ivery (days) (2008)

4.3 2008Average length of stay fornormal del ivery (days) (2010) 4.1 2010 Decrease 4.1 4.2 3.9

Prescription of ambulatory low-cost medications (% DDD ontota l ) (2008)

40,8 2008

Prescription of ambulatory low-cost medications (% DDD on

46.0 2010 46.2 45.9 45.3Prescription of ambulatory low-cost medications (% DDD on 52,8 2012 increase 53,2 52,3 51,6

Share of organised programmfor breast cancer (2008)

51,0 2011

Share of organised programmfor breast cancer (2011) 51.8 2011 increase 72.4 14.0 23.0

Other indicators discussed inthe appropriateness section

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PRICE PER CASE 2012: surgical conditions (ONE DAY /CLASSIC ) (PPP hospital OECD)

One day is more efficient than classic hospitalisation. Day surgery is usually cheaper in Belgium, (-20%--40%) …. Except for cataract surgery (+25%- 40%)

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HSPA Belgium: list of indicators: Efficiency

Indicator Global

Belgium

year Trend over time

Flanders Wal lonia Brussels

Surgica l day,case (%) (2008) 46.2 2008

Surgica l day,case (%) (2010) 47.7 2010 increase 49.9 42.3 49.7

Average length of stay fornormal del ivery (days) (2008)

4.3 2008Average length of stay fornormal del ivery (days) (2010) 4.1 2010 Decrease 4.1 4.2 3.9

Prescription of ambulatory low-cost medications (% DDD ontota l ) (2008)

40,8 2008

Prescription of ambulatory low-cost medications (% DDD on

46.0 2010 46.2 45.9 45.3Prescription of ambulatory low-cost medications (% DDD on 52,8 2012 increase 53,2 52,3 51,6

Share of organised programmfor breast cancer (2008)

51,0 2011

Share of organised programmfor breast cancer (2011) 51.8 2011 increase 72.4 14.0 23.0

Other indicators discussed inthe appropriateness section

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ALOS 2012: GYNECOLOGY

Case DEU AUT ITA FRA LUX BEL ESP CHE IRL FIN SWE GBR DNK NOR NLD Normal delivery 3,8 3,2 4,2 3,9 4,5 2,5 3,6 3,5 2,2 1,5 1,6 3Caesarean section 6,3 6,2 4,2 6,5 6 6,5 4,5 5,9 4,7 4,9 3,9 3,2 3,8 4,9Hysterectomy: abdominal and vaginal 6,8 6,9 5,8 5,4 5,4 4,5 5,1 5,1 5,5 2,6 3,5 3,2 3,1 5Mastectomy 8,8 5,1 5,9 3,3 6,4 4,7 6,7 2,6 2,4 2,8 2,8 3,1

NEAR ALL

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HSPA Belgium: list of indicators: Efficiency

Indicator Global

Belgium

year Trend over time

Flanders Wal lonia Brussels

Surgica l day,case (%) (2008) 46.2 2008

Surgica l day,case (%) (2010) 47.7 2010 increase 49.9 42.3 49.7

Average length of stay fornormal del ivery (days) (2008)

4.3 2008Average length of stay fornormal del ivery (days) (2010) 4.1 2010 Decrease 4.1 4.2 3.9

Prescription of ambulatory low-cost medications (% DDD ontota l ) (2008)

40,8 2008

Prescription of ambulatory low-cost medications (% DDD on

46.0 2010 46.2 45.9 45.3Prescription of ambulatory low-cost medications (% DDD on 52,8 2012 increase 53,2 52,3 51,6

Share of organised programmfor breast cancer (2008)

51,0 2011

Share of organised programmfor breast cancer (2011) 51.8 2011 increase 72.4 14.0 23.0

Other indicators discussed inthe appropriateness section

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Low cost medicines % low cost (DDD/ inh /year )

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Low cost medicines targets and results (Belgium 2013)

Low cost medicines by medical specialities % of target (2013)

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Low cost medicines % low cost ( DDD) versus Expenses (EUR)

expenses

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Low cost medicines: DDD /inh evolution

Quality expenses

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HSPA Belgium: list of indicators: Efficiency

Indicator Global

Belgium

year Trend over time

Flanders Wal lonia Brussels

Surgica l day,case (%) (2008) 46.2 2008

Surgica l day,case (%) (2010) 47.7 2010 increase 49.9 42.3 49.7

Average length of stay fornormal del ivery (days) (2008)

4.3 2008Average length of stay fornormal del ivery (days) (2010) 4.1 2010 Decrease 4.1 4.2 3.9

Prescription of ambulatory low-cost medications (% DDD ontota l ) (2008)

40,8 2008

Prescription of ambulatory low-cost medications (% DDD on

46.0 2010 46.2 45.9 45.3Prescription of ambulatory low-cost medications (% DDD on 52,8 2012 increase 53,2 52,3 51,6

Share of organised programmfor breast cancer (2008)

51,0 2011

Share of organised programmfor breast cancer (2011) 51.8 2011 increase 72.4 14.0 23.0

Other indicators discussed inthe appropriateness section

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Breast cancer screening (50-69)

MISUSE

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1. Introduction

2. Efficiency indicators within Be HSPA

3. Other (in)efficiency indicators within Be HSPA

4. Discussion

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HSPA Belgium: list of indicators: Efficiency

Indicator Global

Belgium

year Trend over time

Flanders Wal lonia Brussels

Surgica l day,case (%) (2008) 46.2 2008

Surgica l day,case (%) (2010) 47.7 2010 increase 49.9 42.3 49.7

Average length of stay fornormal del ivery (days) (2008)

4.3 2008Average length of stay fornormal del ivery (days) (2010) 4.1 2010 Decrease 4.1 4.2 3.9

Prescription of ambulatory low-cost medications (% DDD ontota l ) (2008)

40,8 2008

Prescription of ambulatory low-cost medications (% DDD on

46.0 2010 46.2 45.9 45.3Prescription of ambulatory low-cost medications (% DDD on 52,8 2012 increase 53,2 52,3 51,6

Share of organised programmfor breast cancer (2008)

51,0 2011

Share of organised programmfor breast cancer (2011) 51.8 2011 increase 72.4 14.0 23.0

Other indicators discussed inthe appropriateness section

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HSPA Belgium: list of indicators: What about efficiency in other dimensions ?

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Bed days / inhabitant

Source: OECD Health data 2012

• International comparaison: Nb acute bed days high in B.

= based on RCM/MKG, (exclude one day + RPM / MPG)

OVERUSE:

Inefficiency +

Sustainability issues

Breast cancer screening outside target group (40-49) & (70-80)

• Mammographies réalisées chez les femmes de moins de 50 ans ou de plus de 72 ans

Figure 9. Figure 10.

OVERDIAGNOSIS :

(In) Appropriateness &

safety issues

= Waste -> inefficiency

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Knee Arthroscopy

Unexplained geographical variations

in diagnosis consumption

UNDERUSE , OVER USE ,

MISUSE ? -> inefficiency

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1. Introduction

2. Efficiency indicators within Be HSPA

3. Other (in)efficiency indicators within Be HSPA

4. Discussion

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Discussion (1/3)

Indicator Source Comments/Areas for improvement BE HSPA classif.

BE HSPA indicator

System-wide level

Sub-sector level

DynamicShare of day cases for a selected set of surgical procedures (cataract, tonsillectomy, etc.)

JQNMHCS Good data coverage for patients admitted to hospital, but more limited coverage for outpatient cases

efficiency Surgical day,case

AllocativeAverage length of stay (for all conditions and for 149 specific conditions)

JQNMHCS efficiency Average length of stay for normal delivery (days)

Technical Share of generic pharmaceutical drugs HD Data available in volume and value for two-thirds of OECD countries

efficiency Prescription of ambulatory low-cost medications

Disease-based level

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Discussion (2/3)

Indicator Source Comments/Areas for improvement BE HSPA classif.

BE HSPA indicator

Sub-sector level

Number of consultations per doctor JQNMHCS Can be calculated by dividing the total number of doctor consultations by the number of doctors

sustainability

Acute beddays , Psychiatric beddays

Avoidable hospital admissions (e.g., for asthma, COPD, diabetes, …)

HCQI Also use as an indicator of the quality of primary care

Quality, effectiveness

Hospital admissions for asthma

Disease-based level

Survival rates for selected diseases (in relation to cost)

HCQI and SHA

Need to achieve further progress in data collection on cost by disease

effectiveness

5-years relative survival rate breast cancer

appropriatenes

Caesarean sections (per 1000 live births)

appropriatenes

Use of antibiotics (total DDD/1000inh /day)

appropriatenes

Mammograms outside target group (%)Women aged 40-49 years old

safetyMedical radiation exposure of the Belgian population (MSv/capita)

accessibility

Influenza vaccination (% of the 65+) (2009)

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