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