Quantifying the effects of modelling choices on hospital efficiency measures: A meta-regression analysis

It has often been argued that the results of efficiency analyses in health care are influenced by the modelling choices made by the researchers involved. In this paper we use meta-regression analysis in an attempt to quantify the degree to which modelling factors influence efficiency estimates. The data set is derived from 253 estimated models reported in 95 empirical analyses of hospital efficiency in the 22-year period from 1987 to 2008. A meta-regression model is used to investigate the degree to which differences in mean efficiency estimates can be explained by factors such as: sample size; dimension (number of variables); parametric versus non-parametric method; returns to scale (RTS) assumptions; functional form; error distributional form; input versus output orientation; cost versus technical efficiency measure; and cross-sectional versus panel data. Sample size, dimension and RTS are found to have statistically significant effects at the 1% level. Sample size has a negative (and diminishing) effect on efficiency; dimension has a positive (and diminishing) effect; while the imposition of constant returns to scale has a negative effect. These results can be used in improving the policy relevance of the empirical results produced by hospital efficiency studies.

Efficiency review of Austria’s social insurance and healthcare system: volume 1 – international comparisons and policy options

In 2016, the London School of Economics and Political Science (LSE Health) was engaged by the Austrian Ministry of Labour, Social Affairs and Consumer Protection to undertake an efficiency review of the country’s social insurance system (see Appendix A for the original Concept Note). The review was specifically targeted at health competencies within the social insurance system; for this reason, consideration of accident and pension insurance, as well as other forms of care covered by Federal and Länder governments, were only examined where directly applicable

Zusammenspiel von unterschiedlichen Forschungsmethoden in der Gesundheitsökonomie zur Unterstützung einer rationalen Entscheidungsfindung im Gesundheitswesen

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Patient-level simulation of alternative deceased donor kidney allocation schemes for patients awaiting transplantation in the United Kingdom

In the United Kingdom, the number of patients waiting to receive a kidney transplant far outstrips the supply of donor organs, thereby making some form of rationing inevitable. The criteria for rationing can be made explicit in the design of a kidney allocation scheme, which typically aims to achieve a balance between efficiency, defined as maximising health benefits from a limited resource, and equity in the distribution of that resource. In the past, kidney allocation schemes have focussed on waiting time as one of the criteria to promote equity in access to transplantation. Over time, increasing emphasis has been placed on closer tissue matching between recipients and donors after this was shown to result in better post-transplant outcomes. More recently, there has been recognition of variability in the quality of donor kidneys such that not all donor kidneys will result in equally good survival outcomes and not all patients will derive the same benefit from a given donor kidney. This thesis describes the development of a patient-level simulation model that compares five different approaches to allocating kidneys from across the equity-efficiency spectrum. Emphasis is placed on characterising heterogeneity in the data inputs that are used to inform the simulation. This is achieved by using various regression modelling strategies to analyse patient-level data to facilitate prediction of costs, health-state utilities and survival conditional on covariates such as age, comorbidities and treatment modality. For each allocation scheme, the simulation model reports total costs, life years and quality-adjusted life years across the patient population. The simulation model can be used to quantify not only the magnitude of health gains associated with moving from one kidney allocation approach to another, but also the impact in terms of equity in access to transplantation and the distribution of outcomes across different patient groups. The outputs of the simulation can be used to inform discussions about equity-efficiency tradeoffs in the design of a kidney allocation policy

Cardiovascular disease in Switzerland - health care, mortality and geographical pattern

SUMMARY Switzerland is facing an aging population and a growing amount of patients with chronic diseases. It is crucial to display health care processes and pathways, to identify inequalities and obstacles, and to point out possibilities for improvements of the Swiss health care system (e.g. increase efficiency). The introductory part of the thesis presents a brief description of the Swiss health care system, health services research and regional variation as well as an introduction of CVD and its epidemiological key figures, aetiology and treatments. This is followed by the description of the utilized methods and data, and the objectives of this thesis. The subsequent sections present the four articles included in this thesis. The first article focuses on a small area analysis on regional variation of avoidable hospitalisations in Switzerland including density of primary care physicians and specialists, rurality and hospital supply factors as explanatory variables in the analysis. Lower rates of avoidable hospitalisations were found in areas with very high supply of primary care physicians, increased avoidable hospitalisation rates in areas with more specialists and in areas with higher proportion of rural residents. The second article aims to examine whether emergency patients with acute ST-segment elevation myocardial infarction were adequately treated, i.e. according to the treatment guidelines, in Switzerland. Results show that older and female patients were less likely to receive revascularization which suggests that the treatment guidelines may not be uniformly applied in Switzerland. Similar to the first article, also in the third article a small area analysis was performed but this time investigating regional variation in costs at the end of life. Strongest associations of cost was found with cause of death, age and language region of the decedents. The strong spatial variation of costs could only partly be explained by the included covariates. Article four aims to examine the relationship of distance to different hospital types and mortality from AMI or stroke. We found that AMI mortality in the Swiss population 30 and older and stroke mortality in those 65 and above increased with distance to central and university hospitals, while adjusting for sociodemographic and economic characteristics of the population. The presentation of the four articles is followed by a discussion, which summarizes the main findings and the strengths and limitations of the presented articles. The thesis concludes with a discussion about the challenges for policy, practice and future research