WP2 summary Nov 2011-Jan 2012

Zawada Anna,Krzysztof Rogalskifor WP2 teamHannover Plenary AssembleyFeb 9th, 2012

Agenda of the presentation

Acknowledgements to reviewers! The reviews by WP2 Report chapters – updates

done, the discussion on some reviewers comments

WP2 contribution to WP1 tasks WP2 contribution to WP4 tasks WP2 Work Plan

Quality reviewer: Christian Krönborg

Reviewers remarks no recommendation on „quality of

healthcare” definition incoherent structure some information is repeated in Quality and

Outcome chapters insufficient description of literature review

Quality reviewer: Christian Krönborg

Information has been added:• more precise recommendations, eg. IOM

„quality of healthcare” definition• explanation that the concept of quality in

healthcare contains all areas outlined in the report (outcomes, costs, efficiency, and equity)

• more detailed description of literature review

Quality reviewer: Christian Krönborg

Minor changes:• a few subchapters have been renamed e.g.

chapter 4.1.3 has been renamed to Methods of measuring quality as it contains more general approach to quality not narrowed to quality indicators

• adherence, compliance and persistence have been assigned to Clinical Quality Assessment and process measures

Quality reviewer: Christian Krönborg

New information has been supplemented:• Additional concepts of quality: technical and

functional quality, service triangle• Sociological and psychological concepts of

medical staff–patient relation

Outcomes not reviewed

• This section has not been reviewed• The section has been adjusted to be logically

linked to „Quality” chapter basing on comments of „Quality” reviewer

• authors are still looking forward to the review

Risk adjustmentreviewer: Sören Jensen

In the response to reviewer’s remarks information has been added:

• the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) definition of risk adjustment

• definition of the absolute outcomes measures• explanation of the terms: unadjusted average,

observed outcome, expected outcome, predicted outcome

Risk adjustment reviewer: Sören Jensen

As well as the description of three sources of variation in health outcomes:• systematic variance determined by measurable

patient’s risk factors• random variance determined by unobserved

idiosyncratic characteristics of a patient• valid variance atrributed to true differences in

providers’ quality

Risk adjustment reviewer: Sören Jensen

Discussion added:• discussion of the consequences of omitting

in the model some important risk factors

Minor changes:• the discussion of the literature selection

criteria has been expanded

Costsreviewer: Christian Krönborg

• The overall aim of this chapter was to develop a common terminology and conceptual framework for costs measurement.

• The chosen way to achieve this goal is a review of the state of the art. of calculating costs in economic evaluation.

• The second approach – a review of guidelines for calculating costs is presented as an appendix illustrating functional character of costs calculation.

Costs reviewer: Christian Krönborg

Unclear presentation of literature review

• The systematic and non-systematic review of bibliography:

• In systematic review a too great number of articles was identified, so in addition non-systematic review was performed.

• Articles from both groups have been used.

Costs reviewer: Christian Krönborg

Unclear definition & employment of indicator

• Why we use term „indicator”• A Websterian definition of an indicator is „an

instrument which gives you information”• Therefore we shall speak of a cost as an indicator

of monetary value of resources expanded and it is in this sense used here.

Costs reviewer: Christian Krönborg

Why there are evident repetitions

• Some terms are repeated but each time they are presented from different point of view. (eg. p. 67: generalized definition; p. 75 and other: clarifying from such point of view, of which there is an examination conducted)

Costs reviewer: Christian Krönborg

Why we have used (somewhat old) Canadian guidelines

• The Canadian guidelines (published in 1996) are presented because of their completeness and uniqueness. They are worth thinking about – such guidelines have never been repeated.

• Some older solutions are better than the newest ones

Efficiencyreviewer: Giacomo Pignataro

The aim of this chapter was to develop a common terminology and conceptual framework for efficiency measurement.

By assumption this chapter does NOT concentrate on the specific issues.

Approach taken here is positive and embracing all angles rather than normative. Formulating goals and normative approach is left for health policymakers.

EfficiencyUnclear employment of efficiency conceptThe philosophy employed in our approach was as follows

Efficiency

in PRODUCTION optimal relation b/n input and output sides. allocative efficiency: optimal employment of resources.

in DISTRIBUTION optimal relation b/n consumption and production sides. allocative efficiency: optimal consumption of products.

normative approach for policymakers: „What should be produced?”

‽ ex post economic evaluation

Efficiency reviewer: Giacomo Pignataro

Our approach does not allow to evaluate methods of production

• Presented allocative efficiency (in production) allows to evaluate „How services should be produced” because it reveals the best employment of resources (to achieve efficient allocation of inputs.)

Problem of analysis of efficiency in distribution• Allocative efficiency (in distribution) allows to assess

„What services should be produced” but criterion for optimization includes additional questions for policy makers (to achieve efficient allocation of products)

• Concluding: we focus on efficiency in production.

Efficiency reviewer: Giacomo Pignataro

Choice between outputs and outcomes for analysis

• We concentrate on outputs even though outcomes are even more important from analitical point of view. But problems connected with formulation of a definition and measurement do not allow to use this concept

• In addition: The choice of outcomes is beyond the scope of this chapter

Efficiency reviewer: Giacomo Pignataro

The need to differentiate between deterministic and stochastic methods used in efficiency analysis

• We describe both types of methods and stress problems existing at choosing between DEA and SFA. In addition, we concentrate on questions that should be answered before choosing production function or cost function.

• Possibilities of employment of these two methods – deterministic and stochastic is left for the next step. There is additional question: which inputs/outputs should be chosen? – also left for the next stage of the analysis.

Equity not reviewed

The chapter on equity has not been reviewed

The concept of equity proposed to be discussed in detalis further

WP2 contribution to WP1 tasks A description of current payment methods for physicians and hospitals

by reviewing European Union and OECD sources – a compendium of payment methods by Urszula Cegłowska

The objectives are:

to review single country profiles to see what payment method(s) are used and if there have been any recent changes,

to catalogue by EU country the major payment methods used for paying physicians and hospitals - to set up a table.

Conventional methods of payment for physicans (salary, FFS, capitation, DRG-based payment, episode-based payment, informal payment and lump sum payment) and hospitals (line-item budgets, global budgets, per diem payment, FFS for patient care and DRG/per-stay payment) identified by WP1 will be considered

WP2 contribution to WP4 tasks

A description of the Polish Diagnosis Related Groups (DRG) – the supplement of section “Costs” by Piotr Marusza

Diagnosis Related Group In Poland – description of currently applied indicators of production efficiency in Polish DRG - the supplement of section “Efficiency” by Piotr Marusza

A description of the Polish Diagnosis Related Groups (DRG) – the supplement of section “Costs”

The aim of this section is to concentrate on the specific issue of Polish national DRG systems, which could help in the implementation of next stages of the project.

The objectives of this section:• a description of the pattern on which Polish DRG was developed (Polish

DRG system was modeled on the British system of Healthcare Resource Groups – HRG),

• a description of types of costs covered by the Polish DRG in comparison with the British HRG,

• a description of the method of valuation of case-mix groups in the Polish DRG in comparison with the British HRG,

• a description of the way of covering the costs of inpatient’s treatment in the Polish DRG.

A description of the Polish Diagnosis Related Group (DRG) – the supplement of section “Costs”

The scope of collaborative work on the national DRG systems. Proposed design of the questionnaire:

• Is DRG-like system implemented in the country?• Describe the pattern on which the DRG in your country was

developed.• Describe the types of costs which are covered by the DRG in

your country.• Describe the method of case-mix groups valuation in the DRG in

your country• Describe the way of covering the costs of inpatient’s treatment

in the DRG in your country.

Diagnosis Related Group In Poland – description of currently applied indicators of production efficiency in Polish DRG - the

supplement of section “Efficiency”

The aim of this section is to concentrate on the specific issue of indicators of production efficiency applied in the national DRG systems , which could help in the implementation of next stages of the project.

The objectives of this section:• a description of indicators of production efficiency applied in the British

system of Healthcare Resource Groups (HRG), on the basis of which the Polish DRG was developed.

• a description of indicators of production efficiency applied in the Polish DRG.

• explanation of reasons of differences between indicators of production efficiency applied in the British HRG and the ones applied in the Polish DRG.

Diagnosis Related Group In Poland - description of currently applied indicators of production efficiency in Polish DRG - the

supplement of section “Efficiency”

The scope of collaborative work on indicators of production efficiency applied in the national DRG systems. Proposed design of the questionnaire:

• Describe the indicators of production efficiency applied in the DRG

system on the basis of which the DRG in your country was developed.• Describe the indicators of production efficiency applied in the DRG in

your country.• Explain any reasons of differences between indicators of production

efficiency applied in the DRG system, on the basis of which was developed the DRG in your country and indicators of production efficiency applied in the DRG in your country.

Collaborative work for WP 2

Main problems:Accounting data and it’s uniformity (no uniform

record-keeping across i.e. hospitals)Purchasing power parities (inflation- and income-

adjusted PP)Timeframe for uniform data patterns (i.e in Poland

DRG’s are used only from 2008) Identification of raw (primal) data sources for each

country

The mentioned problems affects:

Task 2.2 and Task 2.3.• Cost, Outcomes & Efficiency issues (measurements)

for all 4 kinds of careTask 2.4. & future data warehouse• Cross country comparative analysis (since we will get

results which should be also comparable moneywise)Future data warehouse• Sources of data for analysis for all 4 areas

Therefore we will need inputs from our partners:

Task 2.2 and Task 2.3.• Cost, Outcomes & Efficiency issues (measurements)

for all 4 kinds of careTask 2.4.• Cross country comparative analysis (since we will get

results which should be also comparable moneywise)Data Warehouse• Sources of data and uniform structure of input

figures

Proposition for division of work

Work Area + Man months• C,E,O Measurements – each WP 1 MMdeadline: end of March 2012• Macroeconomic & sectoral analysis of

analysed countries – 0,5 MMdeadline: end of April 2012• Warehouse data preparation – 0,5 MMdeadline: end of April 2012

• Total manmonths of collaborative work

Workpackage• WP3, WP4,

WP5,WP6• MHH, SDU,

SPH, UI, UniCT, UY

• MHH, SDU, SPH, UI, UniCT, UY

• 10 manmonths

Thank you for your attention!

InterQuality website: http://www.interqualityproject.eu/