Towards a new approach for estimating indirect costs of disease

__Abstract__ Many researchers in the field of evaluation of health care doubt the usefulness of estimates of indirect costs of disease in setting priorities in health care. This paper attempts to meet part of the criticism on the concept of indirect costs, which are defined as the value of production lost to society due to disease. Thus far in cost of illness studies and cost-effectiveness analyses the potential indirect costs of disease were calculated. In the following a first step will be taken towards a new method for estimating indirect costs which are expected to be effectuated in reality: the friction cost method. This method explicitly takes into account short and long run processes in the economy which reduce the production losses substantially as compared with the potential losses. According to this method production losses will be confined to the period needed to replace a sick worker: the so called friction period. The length of this period and the resulting indirect costs depend on the situation on the labour market. Some preliminary results are presented for the indirect costs of the incidence of cardiovascular disease in the Netherlands for 1988, both for the friction costs and the potential costs. The proposed methodology for estimating indirect costs is promising, but needs further development. The consequences of illness in people without a paid job need to be incorporated in the analysis. Also the relation between internal labour reserves and costs of disease should be further investigated. Next to this, more refined labour market assumptions, allowing for diverging situations on different segments of the labour market are necessary

Herziening van de geneesmiddelendistributie in het Sophia Kinderziekenhuis (Academisch Ziekenhuis Rotterdam)

Doelstelling: In het Sophia Kinderziekenhuis is onderzoek verricht ter optimalisering van het geneesmiddelendistributiesysteem. De geneesmiddelendistributie verloopt momenteel op sommige afdelingen via verpleegkundigen en op andere via apothekersassistenten in depotheken. Methoden: De beoordeling van beide distributiesystemen vond plaats aan de hand van de kwaliteitsindicatoren klantgerichtheid, effectiviteit en doelmatigheid. De klantgerichtheid is in kaart gebracht met behulp van interviews. Het vóórkomen van distributiefouten en microbiologische contaminatie zijn beschouwd als effectiviteitsmaten. De doelmatigheid is bepaald met een rekenmodel waarbij het geneesmiddelengebruik is gemeten en tijdmetingen en kostenberekeningen zijn uitgevoerd. Met behulp van het rekenmodel is een aantal alternatieve distributievormen doorgerekend. Resultaten: De geneesmiddeldistributie via depotheken is de meest optimale distributievorm binnen het kinderziekenhuis. De geneesmiddelenbereiding door apothekersassistenten komt tegemoet aan de toenemende complexiteit van medicatiebehoeften in een academisch kinderziekenhuis. Bij het bereiden treedt minder contaminatie op. Bovendien blijkt de depotheek het doelmatigste distributiesysteem te zijn. De nadelen van het systeem van depotheken in de huidige vorm betreffen voornamelijk de inefficiëntie van het registratiesysteem. Daarnaast vindt te weinig sturing plaats op integratie met het primaire proces. Discussie: Automatisering zal de inefficiëntie van het administratieve deel binnen het distributietraject via depotheken grotendeels wegnemen. Daarnaast wordt het management geadviseerd om aandacht te besteden aan meer afstemming met het primaire proces. Op langere termijn verdient uitbreiding van het depotheeksysteem de voorkeur, waarbij rekening zal moeten worden gehouden met zekere randvoorwaarden (bijvoorbeeld omtrent ruimten en ARBO-eisen). Het rekenmodel is onder bepaalde voorwaarden geschikt om ook buiten het Sophia te worden toegepast

Costs of home care for advanced breast and cervical cancer in relation to cost-effectiveness of screening

__Abstract__ The costs of home care in the Netherlands are estimated for women with advanced breast and cervical cancer. We observe a growing role of intensive home care for the terminally ill patients. The average costs of home care are dfl 8500 per patient for breast cancer patients and dfl 7200 for cervical cancer patients. More than half of these costs are incurred in the last month before death. The level of home care in the preceding months is quite modest (dfl 120 per month for both diseases), not taking into account informal care. The costs of home care for patients with advanced cancer are only slightly related to the site of the primary tumor from which the metastases originate. Total average costs per patient during advanced disease, including hospital and nursing home care, amount to dfl 42,700 for breast cancer and dfl 29,000 for cervical cancer. This difference in costs is largely attributable to the longer duration of advanced disease for breast cancer, which substantially affects hospitalcosts. The high costs of care to patients with advanced cancer contribute to a favourable cost-effectiveness ration of those screening programmes which reduce mortality and consequently the costs of care to advanced cancer patients

Kwaliteit en kosten in instellingen voor klinische zorg. Eindrapportage van de toepassing van een kwaliteitsmodel in 5 Nederlandse zorginstellingen 1999-2002

In dit rapport wordt verslag gedaan van de bruikbaarheid en toepasbaarheid van het kwaliteitskostenmodel in de praktijk. Het verslag bestaat uit 2 delen: 1) Externe verslagen over het verloop en de resultaten binnen de kwaliteitsprojecten in de zorginstellingen door de projectteams. 2) Een procesevaluatie met name gericht op de toepassing en het gebruik van kwaliteitskosten bij de uitvoering van de kwaliteitsprojecten. Algemeen blijkt het kwaliteitskostenmodel in de praktijk uitvoerbaar: met behulp van kwaliteitskosteninformatie kunnen knelpunten binnen het zorgproces aangewezen worden en kunnen prioriteiten voor verbetering worden gesteld. De toepasbaarheid van de kwaliteitskosteninformatie voor de besluitvorming binnen de kwaliteitsprojecten is nog beperkt. Hierbij spelen zowel een aantal interne als externe factoren een rol die belemmerend werken: 1) Betrokkenen zijn niet kosten-minded ingesteld, waardoor terughoudend wordt omgegaan met kostenargumenten. 2) Kostenargumenten als zodanig blijken niet direct bruikbaar als motiverend argument om draagvlak te krijgen voor kwaliteitsverbeteringen. 3) Het ontbreekt binnen de zorginstellingen veelal aan een ‘outcome’-gerichtheid die de basis vormt van de werking van het kwaliteitskostenmodel. 4) De huidige Functiegerichte Budgettering biedt weinig prikkels om vermijdbare kosten binnen het zorgproces te doen dalen of om te komen tot omzetvergroting. In het algemeen gaat de aandacht vooral uit naar mogelijkheden voor financiële besparingen (beïnvloeding op geldstromen). De mogelijke economische besparingen vragen om topdown ondersteuning en sturing vanuit het management. Daarnaast vraagt de toepassing van de methode expertise om consequenties van financiële en economische kosten in te passen in beleidsbeslissingen binnen de zorginstellingen

Choosing cooperation over competition; hospital strategies in response to selective contracting

With the introduction of market competition in health care, the Dutch government enabled health insurers to contract hospital care selectively. The assumption is that “selective contracting” will stimulate efficiency, effectiveness, and innovation and will diminish overcapacity. In 2010, the first Dutch health insurers started experimenting with “selective contracting” by setting a minimum treatment volume per year for complex treatments. In an explorative, multiple case study among 15 hospitals in five regions, we found that instead of competing, hospitals started to cooperate and strengthen their networks. The government intended to remove redundant hospital capacity and improve quality by stimulating specialization and concentration. Our study showed that specialization was indeed stimulated, which may have increased quality of care. However, facilitated by the absence of a countervailing power (government or insurer), hospitals in our cases negotiated to the effect of preserving hospital capacity. Within the current political debate between supporters of competition and advocates of a national health service, the importance and role of the (medical) networks should be taken into account. Otherwise, the outcomes of health care governance will be different than intended by either party

Productivity and quality of Dutch hospitals during system reform

This study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In particular, we consider how hospital efficiency has developed. As the reform created an environment of regulated competition, we pay special attention to relative efficiency. Our results suggest that the differences in efficiency among hospitals have become larger. In the years 2009–2010, the number of hospitals identified as (close to) efficient by DEA analysis decreased

How cost-effective is breast cancer screening in different EC countries?

Should the decision to start breast cancer screening in the Netherlands and in the U.K. be followed by other EC countries? This question has been addressed in an exploratory analysis of the differences in cost-effectiveness of breast cancer screening in Spain, France, the U.K. and the Netherlands. A detailed cost-effectiveness analysis of breast cancer screening in the Netherlands has been used as the starting point. Country specific data on incidence, mortality, demography, screening organisation and price levels in health care have been used to predict the costs and effects of nationwide screening programmes, in which women aged 50–70 are invited for 2-yearly mammographic screening. The relative effect of screening is highest in the U.K. (16.55 life-years gained per 1000 screens) and lowest in Spain (8.23 life-years gained per 1000 screens). The cost per screen is highest in Spain (£38) and lowest in the U.K. (£18). In comparison with the yearly health expenditures per capita, the cost per life-year gained is 2.8 times higher in the Netherlands, 3.1 times higher in the U.K., 6.5 times higher in France and 20.6 times higher in Spain. These marked differences show that no uniform policy recommendations for breast cancer screening can be made for all countries of the EC

Creating patient value in glaucoma care

Purpose: The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. Design/methodology/approach: In a retrospective case study an in-depth evaluation of the use of a quality cost mode

Integral costs of head and neck oncology (in Dutch)

OBJECTIVES: In the Netherlands, budgeting systems allocate funds to finance academic care. For some highly specialized treatments, it is felt that the costs are not well reimbursed. This study compared hospital reimbursements for head-neck oncology with real costs. To reflect future care costs, costs of required improvements in the quality of care were also estimated. DESIGN: This study was based on 854 consecutive patients treated between 1994-1996 in two university hospitals. Full costs of medical consumption were determined. RESULTS: Costs of diagnosis, treatment and two years of follow-up of patients with a primary head or neck carcinoma summed up to f 47848 (E 21712). For patients with a relapsed carcinoma, this amount was f 61088 (E 27721). After two years, the relapse rate is 40%. Costs per new patient were therefore calculated as 1*47848 + 0.4*61088. The costs of 10 years of follow-up were f 755 (E 343) after correction for survival. In total, average costs per new patient were f 73344 (E 33282), which covered costs of treating the primary tumour, costs of treating relapsed tumours in 40% of all patients and the costs of 10 years of follow-up. The current reimbursement is f 26786 (E 12155). Costs of enhancing quality of care (including enlarging doctor's time) were f 3700 (E 1679) per new patient. CONCLUSIONS: Actual costs of treating head-neck carcinoma are 2.88 times higher than the hospital reimbursement. The actual costs for this type of highly specialized care are not covered by the reimbursement system, which should therefore be revised

Landelijke evaluatie van bevolkingsonderzoek naar borstkanker in Nederland. 1990-2007 (XII). Het twaalfde evaluatierapport

Introduction: The last detailed report from the National Evaluation Team for Breast cancer screening (NETB) on the Dutch breast cancer screening programme appeared in 2005. It presented the screening results up until the end of 2003 which, however, were incomplete for some regions. The same applies to the two brief interim reports that were released in 2006 and 2007. The new evaluation report adds four reporting years to the entire evaluation period, i.e. those from 2004- 2007. The fact that this 12th report by the NETB is based on complete nationwide data on the screening activities of all nine screening regions is particularly good news. This is thanks to the additional efforts made by the two regions that had had a backlog of screened women’s follow-up data for years, enabling the backlog to be eliminated by spring 2009. It also enabled the optimum analysis of 18 years of national population research, and the presentation of the results without qualification. Unfortunately, this does not apply to the data on interval cancers which, subsequent to 1999, are far from being fully available at national level...