Measuring Health System Efficiency in Canada

Multi-phased project

Phase I

1

Katerina GapanenkoApril 17, 2012

The increased cost of health is a great concern

0

50

100

150

200

250

1975 1981 1987 1993 1999 2005 2011

Health Care spendings in Canada

Actual Spending Inflation-Adjusted Spending ($1997)

2Source National Health Expenditure Database, CIHI.

The increased cost of health is a great concern

3

Total Health Expenditure per Capita (Source: OECD Health Data, 2011)

Health expenditure per capita varies

4

$5,261

$6,884

Total Health Expenditure per Capita, in current dollars, 2011 forecasted Source: National Health Expenditure Trends 1975-2011, CIHI

$11,929

$5,450

$8,996

$6,570

$5,792

5

Are we getting the most out of our health

system dollars?

Previous Studies

66

Project Big Picture

7

Defining

a model

Testing

the model

Working

with DMUs

Enhancing

the model

Common Approaches to Measuring Efficiency

System -level approach

Sub-sector approach

Disease-based approach

8

Common Steps

9

Estimating efficiency of

DMUs

efficiency

scores

Factors that might be

associated with score

variation

Regression Analysis

Correlations

Inputs Outputs

Model Components

10

Health System

DMU

DMU

DMU

DMU

Methods of measurement

SystemObjectives

Stakeholders’ Contribution to Defining System Objectives

• “Someone on behalf of society has to decide what

objectives ought to be pursued. That is rarely a

role for analysts or researchers – rather, it is the

legitimate role of politicians. In developing a

performance model, an important requirement is to

seek out a clear political statement on what is

valued from legitimate stakeholders.”

Smith and Street, 2009

11

Research Methods

12

• Broad theoretical literature review

• Review of applied studies

• Statistics Canada

• CIHI

• Stakeholder interviews (CHEPA, McMaster) o 17 senior health system officials from 9 provinces & 2 territories

• Stakeholder dialogue (McMaster Health Forum)o 16 health system decision-makers from 6 provincial, 1

territorial and federal governments

• Review of jurisdictional documents

Literature reviews

Qualitative studies

Data reviews

Model Components

13

What is the system objective?&

How can we measure it?

System Objective: To produce more services?

14

To improve overall population health?

15

To improve health services to people in need?

16

System Objectives

17

• Premature mortality • Avoidable mortality• Preventable mortality• Treatable mortality

Model Components

18

Health System

SystemObjectives

Throughputs (wait times)

19

Throughputs(wait times)

Inputs

20

• Cost of hospitals• Cost of other institutions• Cost of physicians• Cost of nurses• Cost of other health professionals• Inflow/outflow rate• Public health expenditures• Drugs public expenditure

Environmental Factors

21

• Population density• Unemployment rate• Average income• % of people over 65• % of Aboriginals• % of immigrants• Income inequality (GINI)• Gender distribution

Lifestyle Factors

22

• Proportion of smokers• Obesity rate• Physical activity• Fruit & vegetable consumption• Alcohol consumption

Throughputs (for regression analyses)

23

• 30-day AMI or stroke in-hospital mortality

• Readmission for AMI, asthma, mental illness and other diseases

• Wait time for certain procedures

•Concentration Indices for self-reported

•Access to family physicians

•Visits to GP and specialists

•Hospitalization

•Health status

Health

Inequalities

Performance

Indicators

Model Components

24

Health System

Methods of measurement

SystemObjectives

DMU

DMU

DMU

DMU

DMUs

25

• Policy creation

• Authority for use of resources

• Intra- and inter provincial/territorial better performers

• ~ 140 health regions versus 13 provinces/territories

•Health regions

Methods of estimating efficiency

26

Key Differences DEA SFA

Sensitivity to extreme observations

High Low

Assumption that some DMUs are 100% efficient

Present Absent

Sensitivity to underperformers None High

Separation of random error from inefficiency

Impossible Possible

Assumptions about functional form and error distribution

None Strong

Many system outcomes Yes No

Impact of the sample size Moderate Strong

•Both methods

Model

SFA & DEA

efficiency

scores

•Cost of hospitals

•Cost of other institutions

•Cost of physicians

•Cost of nurses

•Cost of other health professionals

•Inflow/outflow rate

•Public health expenditures

•Drugs expenditure

Inputs

•Premature mortality

•Preventable mortality

•Treatable mortality

•Avoidable mortality

•Population density

•Unemployment rate

•Average income

•% of people over 65

•% of Aboriginals

•% of immigrants

•Income inequality (GINI)

•Gender distribution

Outcomes

Env. Factors

DMUDMU

DMU

DMUDMU

DMU

•Proportion of smokers

•Obesity rate

•Physical activity

•Fruit & vegetable consumption

•Alcohol consumption

Lifestyle Factors

Regression analysis

28

•30-day AMI or stroke in-hospital mortality•Readmission for AMI, asthma, mental illness and other diseases

•Wait time for certain procedures

•Concentration Indices for self-reported •Access to family physicians•Visits to GP and specialists•Hospitalization•Health status

•Proportion of smokers•Obesity rate•Physical activity•Fruit and vegetable consumption•Alcohol consumption

Lifestyle factors

Health Inequalities

Performance Indicators

efficiency

scores

Regression

Analysis

Correlations

Challenges & Limitations

29

• Missing data

• Lack of real-time data

• Variations in responsibilities among health regions

• Information challenges

• Model acceptance challenges

Next Steps

30

Defining

a model

Testing

the model

Working

with DMUs

Enhancing

the model

Acknowledgment

31

Dr. Michel Grignon Dr. Sara Allin

Dr. Jeremy Veillard

Alexey Dudevich Jean Harvey

Thank you

32