Study of the Variations in the Use of Hospital Services, Based on the Case Mix, in 2008 in Romania

The healthcare system copes with economic challenges worldwide, so the healthcare reform is a topic more important than ever for social policies. What do we get for our money? Is a question that raises more and more. It has been shown that more healthcare services does not necessarily mean a better health. Many countries focus of medical practice variations or health disparities. The collection of case mix data starting with 2003 in Romania made possible several studies concerning practice variations in Romania. The present article shows how these data can be used to provide accurate comparisons in geographic profile concerning the volume of services, territorial disparities and to hypothesize about the possible causes of practice variations. Key words: Hospitals, medical practice variations, territorial disparities, case mi

The Burden of Cancer and Market Access for New Oncology Drugs in European Countries

Obiectiv: Studiul are ca obiectiv evaluarea poverii şi a costului asociat patologiei cancerului, să ofere o privire de ansamblu asupra resurselor disponibile pentru tratamentul cancerului în ţările europene, inclusiv România, precum şi evaluarea modului în care acestea sunt corelate cu accesul pe piaţă al noilor medicamente oncologice.Metodologie: O analiză a poverii cancerului în ţările europene, precum şi o comparaţie a acesteia pe tipuri de cancer pentru România a fost realizată utilizând date din cercetări de piaţă locale, precum şi date ale unui studiu descriptiv, retrospectiv, asupra bazei de date cu patologia spitalizată în România în anul 2008.Rezultate: Incidenţa cancerului în ţările europene este în creştere, pe primele trei locuri situându-se cancerul de sân, cancerul colorectal şi cancerul de prostată. Există o mare variaţie între ţările europene în ceea ce priveşte resursele alocate pentru terapia cancerului şi adaptarea tratamentului cu noile medicamente oncologice. România este printre ţările cu cea mai mică cheltuială pe cap de locuitor pentru tratamentul cancerului, în timp ce incidenţa este comparabilă cu cea din alte ţări central şi est europene. Cel mai mare volum de cazuri spitalizate sunt pentru cancerul de sân, colorectal şi de plămân.  Cazurile sunt tratate prin serviciile medicale furnizate în spitalizarea continuă şi în spitalizarea de zi, totalizând un număr important de episoade de spitalizare.Concluzii: In România, datele despre complexitatea cazurilor pot fi utilizate pentru a măsura povara cancerului în termeni de evoluţie a volumului cazurilor pe tipuri de cancere, şi pe diagnostice. Costurile cu tratamentul cancerului sunt mari, însă cea mai mare parte reprezintă costuri indirecte (2/3) cum ar fi cele cu pierderile în productivitate datorate bolii, care generează o povară economică importantă pentru societate. În această perspectivă, costurile ridicate ale noilor terapii sunt, de cele mai multe ori, contrabalansate de beneficiile rezultate din prelungirea vieţii şi creşterea calităţii vieţii pacienţilor. Pe baza acestui studiu, cele mai importante probleme de analizat în viitor sunt inechitatea în accesul pacienţilor din zone diferite ale ţării, în special din zonele izolate, la îngrijirile de specialitate din spitale, precum şi accesul pe piaţă al noilor medicamente oncologice determinate de procesul decizional întârziat de rambursare a acestor terapii, în urma obţinerii autorizaţiei de punere pe piaţă. Un Registru Naţional pentru Cancer funcţional (încă în dezvoltare) precum şi resurse adiţionale disponibile pentru tratamentul în ambulator ar putea creşte accesul pacienţilor la tratament.Cuvinte cheie: evaluarea poverii, evaluarea costului, accesul pe piața medicamentelor în patologia oncologicăObjective: Aim of the study is to show the burden and cost of cancer, to overview the resources available for cancer treatment in European countries including Romania, and see how these relate to the countries market access for new oncology drugs.Methodology: An analysis of burden of cancer in European countries was performed by looking at various disease indicators from international studies, with a comparison per types of cancer for Romania based on local market research and a retrospective descriptive study on data from National Hospital database for 2008.Results: The incidence of cancer in European countries is increasing, top three cancers as number of cases are breast, colorectal and prostate cancer. There are wide variations between European countries regarding resources allocated to cancer therapy and absorption of new oncology drugs. Romania is among countries with the lowest spending for cancer treatment in EU although cancer incidence is comparable with other Eastern European countries. The most frequent types of cases hospitalized are for breast, colorectal and lung cancer. Cases are treated in day hospital and inpatient settings, and they are usually associated with intravenous chemotherapy and surgical procedures, resulting in a large number of episodes of care.Conclusions: In Romania, case-mix data can be used to show the real burden of cancer, in terms of evolution of volume of cases per types of cancer and per diagnoses. Costs of care for cancer patients are high, but most part (2/3) represent indirect costs, such as costs with loss of productivity due to disease, which generate an important economic burden for the society. In this holistic perspective, high costs of new therapies are in most of cases outweighed by future benefits from prolonging life and increased quality of life for cancer patients. Based on the analysis, important issues to be addressed in near future are the inequity in access between different regions to specialized oncologic care, and the delays in market uptake of new oncology drugs due to delayed reimbursement decisions following market authorization. Also, a functional National Cancer Registry (still under development) and additional resources for treatment in outpatient settings could improve patient access to treatment.Key words: burden of cancer, cost evaluation, market acces for new oncology drugs

Standard comparison of local mental health care systems in eight European countries

Aims. There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (>= 18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sor-Trondelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.Peer reviewe

O scurta analiza a disparitatilor teritoriale in consumul de servicii spitalicesti destinate cazurilor acute, in Romania

Summary: Purpose: to study the geographical disparities in the consumption of hospital services and their potential causes Methodology:The study presented in the article is a descriptive observation one, conducted for the year 2008. The analysis included all the cases discharged from continuous acute care hospitals in Romania, considered valid.There were studied the following hypotheses:the excess in consumption of hospital services (measured by the standardized ratio of the cases and of the hospitalization days, according to the age group) is associated with a lower standard of living and a greater number of bedsthe excess consumption of hospital services generates a reduction of the mortality in the general population in that geographic areas (measured by the standardized mortality report by age group).The association between these variables was tested for the 8 development regions (the Spearman correlation test) respectively for the patient's home county (the Pearson correlation test), using the statistical analysis software SPSS. Results:Although differences in the consumption of among the different development regions, respectively among the counties, are obvious, no association between the high volume of hospital services and mortality was found; therefore, it can be assumed that excessive consumption of services is not accompanied by an improving of the health status of patients as mortality reduction. The income influences poorly the volume and the outcome of the healthcare, but correlates with the number of hospital beds in counties with a higher income level.  There is no correlation between the number of hospital beds and the volume of the consumed services. Although, at county level, the correlation between the number of cases and the hospitalization days are proven, there are development regions that surprises by the overall scarcity of cases, but excess hospital days. Conclusions     There are variations in hospital care practice, which should be measured and analyzed in terms of causes, and should be prevented through monitoring the service needs, data reporting and the careful assessment of the structures and the resources.Scop: studierea disparitatilor geografice in consumul de servicii spitalicesti si a potentialelor cauze ale acestora. Metodologie: Studiul prezentat in articol este unul observational descriptiv, desfasurat pentru anul 2008. Au fost incluse in analiza toate cazurile externate din spitalele de acuti din Romania, considerate valide. Ipoteze de studiu:1.       excesul de servicii spitalicesti consumate  (masurate prin raportul standardizat al cazurilor si al zilelor de spitalizare in functie de grupa de varsta) se asociaza cu un nivel de trai mai scazut si cu un numar de paturi mai mare.2.       excesul de servicii spitalicesti determina in zonele geografice respective o scadere a mortalitatii in populatia generala (masurata prin raportul standardizat al mortalitatii dupa grupa de varsta).Testarea asocierii a fost facuta la nivelul celor 8 regiuni de dezvoltare (test corelatie Spearman), respectiv judet de domiciliu al pacientului (test corelatie Pearson), cu programul de analiza statistica SPSS. Rezultate: Desi diferentele in consumul de servicii spitalicesti la nivelul regiunilor de dezvoltare, respectiv judetelor, sunt evidente, nu a fost gasita nici o asociere intre volumul mare de servicii spitalicesti si mortalitate; ca urmare, consumul excesiv nu este insotit de imbunatatirea starii de sanatate a pacientilor in sensul scaderii mortalitatii. Venitul influenteaza in mica masura volumul si rezultatul ingrijirii, dar se coreleaza cu numarul paturilor de spital din judetele cu un nivel mai mare al veniturilor. Nu exista o corelatie intre numarul paturilor de spital si volumul serviciilor consumate. Desi la nivel de judet exista corelatie dovedita intre numarul de cazuri si cel al zilelor de spitalizare, exista regiuni de dezvoltare care surprind global prin deficitul de cazuri dar exces de zile de spitalizare. ConcluziiExista variatii de practica in ingrijirile spitalicesti, care trebuiesc masurate si analizate din punct de vedere al cauzelor, si prevenite, prin monitorizarea nevoilor de servicii, raportarii datelor, precum si prin evaluarea atenta a structurilor si resurselor alocate

Aspecte evolutive, variatii ale activitatii spitalicesti si ale practicii chirurgicale -per ansamblu si din perspectiva unor grupuri vulnerabile de pacienti

The whole modern health management aims to shift the healthcare from hospitals to outpatient care. During last decades, EU reduced the number of hospital beds, the length of stay, trying to improve the efficiency of the health system. Is this possible to be done, preserving in the same time the equal coverage with health services, limiting the practice variations? The present study presents the evolution of the main indicators for the volume of hospital and surgical activity; some of differences recorded among regions or patient groups, and identifies features of the surgical practice concerning some vulnerable age groups of patients: children and elderly. The conclusions point out that the hospital activity increased, but varied among districts and age groups. There are some surgical interventions that occur very often in children or consume many hospital days in elderly that might need special analysis in order to evaluate their appropriateness or efficiency.Intregul management medical modern isi propune sa redirectioneze ingrijirile de sanatate din spitale catre asistenta extraspitaliceasca. In ultimele decade, UE a redus numarul paturilor de spital, in incercarea de a imbunatati eficienta sistemului de sanatate. Este posibil sa se intample aceasta, pastrand in acelasi timp acoperirea echitabila cu servicii de sanatate, limitand variatiile de practica? Studiul prezinta evolutia principalilor indicatori de volum ai activitatii spitalicesti si chirurgicale, unele diferente  intre regiuni si grupe de varsta, identificand caracteristici ale activitatii chirurgicale din perspectiva unor grupe vulnerabile de pacienti: copiii si batranii.  Concluziile arata ca activitatea spitaliceasca a crescut, dar a variat intre judete si grupele de varsta. Exista unele interventii chirurgicale foarte frecvente la copii sau care consuma un numar mare de zile de spitalizare la pacientii varstnici, acestea putand necesita analize speciale care sa le evalueze adecvarea sau eficienta

Particularităţi privind utilizarea spitalelor de urgenţă - România 2007

Hospital is the focal point of the health care system. Within the hospital sector, emergency hospital is a major component, and we can provide statistical evidence useful for health planning policy by highlighting territorial particularities. The level of hospital utilization can be appreciated by measuring the activity, and also, the population accessibility to hospital care services can be indirectly estimated through measuring the solicited healthcare services by population. In Romania, the hospital system meet an older territorial layout, which largely covers the needs of population, but which should take into account the current Romanian context characterized by the need of a European standards harmonization and by regional development.Keywords: emergency hospital utilization, addressability to emergency healthcare services, territorial particularities.Sectorul spitalicesc reprezintă pivotul sistemului de îngrijiri de sănătate. În cadrul sectorului spitalicesc, spitalele de urgenţă reprezintă o componentă majoră , iar evidenţierea particularităţilor teritoriale poate furniza dovezi statistice utile pentru proiectarea politicilor de planificare sanitară. Nivelul utilizării spitalelor poate fi apreciat prin nivelul activităţii, iar accesibilitatea populaţiei la acest tip de servicii se poate măsura, indirect, prin măsurarea nivelului solicitărilor acestor servicii de către populaţie. În România, sistemul spitalicesc respectă o mai veche arondare teritorială, care acoperă în mare măsură nevoile populaţiei, dar care ar trebui să ţină seama şi de contextul actual caracterizat de nevoia armonizării la standardele europene şi dezvoltării regionale.Cuvinte cheie: utilizarea spitalelor de urgenţă, adresabilitatea populaţiei la serviciile de urgenţă, particularităţi teritoriale

Aspecte privind activitatea spitalicească - România, 2007

Hospital is the focal point of the health care system. Bz this study, we proposed to provide statistical evidence useful for health planning policy by highlighting the activity’s aspects and territorial particularities. The level of hospital utilization can be appreciated by measuring the activity, and also, the population accessibility to hospital care services can be indirectly estimated through measuring the solicited healthcare services by population. In Romania, the hospital system meet an older territorial layout, which largely covers the needs of population, but which should take into account the current Romanian context characterized by the need of a European standards harmonization and by regional development.Keywords: hospital activity, episodes of hospitaliyation, days of hospitalization, lenght of staySectorul spitalicesc reprezintă pivotul sistemului de îngrijiri de sănătate. Evidenţierea particularităţilor teritoriale poate furniza dovezi statistice utile pentru proiectarea politicilor de planificare sanitară. Nivelul utilizării spitalelor poate fi apreciat prin nivelul activităţii, iar accesibilitatea populaţiei la acest tip de servicii se poate măsura, indirect, prin măsurarea nivelului solicitărilor acestor servicii de către populaţie. În România, sistemul spitalicesc respectă o mai veche arondare teritorială, care acoperă, în mare măsură, nevoile populaţiei, dar care ar trebui să ţină seama şi de contextul actual caracterizat de nevoia armonizării la standardele europene şi dezvoltării regionale.Cuvinte cheie: activitatea spitalicească, episoade de spitalizare, zile de spitalizare, durata de spitalizare

Retrospective Analysis of Use and Distribution of Resources in Otolaryngology Wards in Romanian Hospitals Between 2003 and 2008 to Improve Provision and Financial Performance of Healthcare Services

Aim To analyze use and distribution of resources by otolaryngology (ENT) hospital wards in Romania between 2003 and 2008, in order to plan the improvement of patient access to health care services and health care services’ financial performance. Methods Clinical electronic records were searched for all patients discharged from all public hospitals funded on a per-case basis by the government between January 2003 and September 2008. Adult and pediatric ENT wards, as well as ENT wards from different counties, were compared. Results The number of ENT hospital beds and the number of specialists decreased from 2003 to 2004, the number of specialists declined, and specialists were distributed unevenly among the hospitals and counties. The total number of ENT wards was over 100 for almost the entire study period, but there were only about 15 pediatric ENT wards in all 42 counties. ENT wards recorded more cases and hospitalization days than oral-maxillofacial surgery and neurosurgery wards, but fewer cases than general surgery or obstetrics wards. ENT wards had the lowest mortality rates. Until the second half of 2007, adult ENT wards had a lower surgical index, higher complexity of cases, and longer average length of stay than pediatric ENT wards (P < 0.001, t-test). After 2007, pediatric ENT wards treated more complex cases (P = 0.004, t -test) that were less surgical in nature; this result was due to the shift from the Health Care Finance Administration classification diagnostic-related group (DRG) system to the Australian Refined DGR system, as well as to improper use of codes. ENT wards in different counties differed in the number of cases, average length of stay, and case mix index. Conclusion Statistics and case mix clinical data may be a good starting point for informing hospital management to assess ENT service coverage, but they should be supplemented with data on hospitalization costs

Distribuţia teritorială şi utilizarea spitalelor de urgenţă – România, 2007

Health planning policies should be based on scientific and valid evidence related to existing and  foreseen resources. The hospital healthcare system is a huge source of resources but also represents the sector of healthcare system with the highest level of expenditure all over the world. Medical emergencies is a priority for the provision of health care for each country; ensuring equitable access to services and especially the emergency services should be permanently included on the agenda of the ministry concerned. The scarcity of financial resources in the health sector leads to an acute need to develop strategies based on prioritization of the needs of the population, and this prioritization must be obligatory supported by solid, valid and timely evidence. Mapping the hospital units can provide a better understanding of the provision of hospital services and of the use of health services provided in emergency hospitals.Keywords: hospital availability, graphical analysis, emergency hospital services utilization.Politicile de planificare sanitară ar trebui să fie bazate pe evidenţe ştiinţifice valide privind resursele existente şi cele preconizate pentru &icirc;ndeplinirea obiectivelor acestor politici. Peste tot &icirc;n lume, sistemul spitalicesc reprezintă o importantă sursă de resurse, dar reprezintă, totodată, şi sectorul de asistenţă medicală cu cel mai &icirc;nalt nivel de cheltuieli din sistemul sanitar. Urgenţele medicale sunt o&nbsp; prioritate pentru domeniul furnizării de servicii medicale; asigurarea accesului echitabil la servicii medicale, &icirc;n special la serviciile de urgenţă, ar trebui să fie permanent incluse pe ordinea de zi a ministerului de resort. Limitarea resurselor financiare din sectorul sănătăţii conduce la o nevoie acută de a dezvolta strategii, pe baza prioritizării nevoilor populaţiei, iar această prioritizare trebuie să fie obligatoriu susţinută de dovezi solide, valabile şi oportune &icirc;n timp. Cartografierea unităţilor spitaliceşti poate oferi o mai bună &icirc;nţelegere privind&nbsp; oferta spitalicească şi utilizarea serviciilor furnizate &icirc;n spitalele de urgenţă.Cuvinte-cheie: disponibilitatea spitalelor, analiza grafică, utilizarea serviciile spitaliceşti de urgenţ

Morbiditatea spitaliceasca prin cancer de col uterin - Romania, 2009

Cancer is responsible for a large share of deaths, worldwide as well as in Romanaia, and induces high costs (for individuals, health system and society), proved to be one of the most burdensome diseases.Lately, problems induced by cancer in women are increasing, due to the raise in incidence, but mainly to the high mortality rate of cervix cancer. Hospitals having obstetrics-gynecology departments are the main medical units who provide specialized services for diagnosis, staging and treatment of cervix cancer; the most of cervix cancers cases are recorded in hospital care sector, and the analysis of hospital morbidity may offer a pretty fair picture of the phenomenon. The present paper presents some results of the analysis of the hospital morbidity trough cervix cancer, in hospitals who reported clinical data at patient level, during the first eight months of the year 2009.Key words: geographic distribution of hospitalizations, the profile of hospitalization, surgical procedures for cervix cancer in hospitalCancerul este responsabil pentru o mare parte dintre decese, atat la nivel mondial, cat si in Romania, si induce costuri mari (la nivel individual, sistem de sanatate si societate), dovedindu-se a fi una dintre cele mai impovaratoare afectiuni. Problematica indusa de cancer in randul femeilor cunoaste o amploare crescuta in ultimul timp, ca urmare a incidentei in crestere, dar mai ales a ratei mari de mortalitate pe care localizarea la nivelul colului uterin o determina. Spitalele in care exista o sectie de obstetrica-ginecologie reprezinta principalele unitati medicale in care se acorda servicii specializate, in vederea diagnosticarii, stadializarii si tratarii cancerului de col uterin; cea mai mare parte a cazurilor de cancer de col uterin sunt inregistrate in asistenta spitaliceasca, iar analiza morbiditatii spitalicesti poate oferi o imagine destul de fidela a fenomenului. Articolul de fata prezinta rezultate ale analizei morbiditatii spitalicesti prin cancer de col uterin, la nivelul spitalelor care au raportat date la nivel de pacient, in primele 8 luni din anul 2009.Cuvinte cheie: distributia teritoriala a spitalizarilor, profilul spitalizarilor, interventii chirurgicale in cancerul de col spitalizat