Functional mapping of hospitals by diagnosis-dominant case-mix analysis

BACKGROUND: Principles and methods for the allocation of healthcare resources among healthcare providers have long been health policy research issues in many countries. Healthcare reforms including the development of a new case-mix system, Diagnosis Procedure Combination (DPC), and the introduction of a DPC-based payment system are currently underway in Japan, and a methodology for adequately assessing the functions of healthcare providers is needed to determine healthcare resource allocations. METHODS: By two-dimensional mapping of the rarity and complexity of diagnoses for patients receiving treatment, we were able to quantitatively demonstrate differences in the functions of different healthcare service provider groups. RESULTS: On average, inpatients had diseases that were 3.6-times rarer than those seen in outpatients, while major teaching hospitals treated inpatients with diseases 3.0-times rarer on average than those seen at small hospitals. CONCLUSION: We created and evaluated a new indicator for DPC, the diagnosis-dominant case-mix system developed in Japan, whereby the system was used to assess the functions of healthcare service providers. The results suggest that it is possible to apply the case-mix system to the integrated evaluation of outpatient and inpatient healthcare services and to the appropriate allocation of healthcare resources among health service providers

Health services research related to performance indicators and benchmarking in Europe.

OBJECTIVE: Measuring quality of care through performance indicators and subsequently using these to compare, learn, and improve (benchmarking) has become a central component of health care policy. This paper aims to identify the main themes of health services research in this area and focuses on opportunities for improving the evidence underpinning performance indicators. METHODS: A literature survey was carried out to identify research activities and main research themes in Europe in the years 2000-09. Identified literature was categorized into sub-topics and for each topic the main methodological issues were identified and discussed. Experts validated the findings and explored the potential for related further European research. RESULTS: The distribution of research on performance and benchmarking across EU member states varies in time, scope and settings with a large amount of studies focusing on hospitals. Eight specific fields of research were identified (research on concepts and performance frameworks; performance indicators and benchmarking using mortality data; performance indicators and benchmarking related to cancer care; performance indicators and benchmarking on care delivered in hospitals; patient safety indicators; performance indicators in primary care; patient experience; research on the practice of benchmarking and performance improvement). Expert discussions confirmed that research on performance indicators and benchmarking should focus on the development of indicators, as well as their use. The research should involve the potential users and incorporate scientific approaches from biomedicine and epidemiology as well as the social sciences. Further progress is hampered by data availability. Issues which need to be addressed include the use of unique patient identifiers (UPIs) to facilitate linkages between separate databases; standardized measurement of the experiences of patients and others; and deepening collaboration between Eurostat, the World Health Organization (WHO), and the Organization for Economic Co-operation and Development (OECD) to facilitate the availability of internationally comparable performance information. CONCLUSIONS: This study suggests a number of themes for future research. These include testing and improving: the validity and reliability of performance indicators, especially related to avoidable mortality and other outcome indicators; the effectiveness and efficiency of embedding performance indicators in the various governance, monitoring and management models, and their effect on health systems, services and professionals; and the effectiveness and efficiency of linking performance indicators to other national and international strategies and policies such as accreditation and certification, practice guidelines, audits, quality systems, patient safety strategies, national standards on volume and/or quality, public reporting, pay-for-performance and patient/consumer involvement. The field would benefit from strengthening the clearinghouse function for research findings, training of researchers and appropriate scientific publication media. Results should be systematically shared with policy-makers and managers, and networking stimulated between the growing number of regional and national institutes involved in quality measurement and reporting

From policy to practice: changing government attitudes towards the private sector in Malawi

This paper reviews relations between government and the private sector in Malawi from independence to the present. The analysis charts the changing emphasis that official policy has attached to the role of the private sector throughout the transition from dictatorship to democracy; and from a PRSP that effectively ignored the role of the private sector in national development, to the current more balanced approach that recognises the private sector as the 'engine of economic growth' and the best means of achieving poverty reduction. However, in spite of progress, Malawi's private sector remains fragile and while the rhetoric from the highest levels of government towards the private sector has evolved, the enabling environment for private sector development is still inhospitable. Copyright © 2007 John Wiley & Sons, Ltd.

Austerity and health in Europe

Many European governments have abundantly cut down public expenditure on health during the financial crisis. Consequences of the financial downturn on health outcomes have begun to emerge. This recession has led to an increase in poor health status, raising rates of anxiety and depression among the economically vulnerable. In addition, the incidence of some communicable diseases along with the rate of suicide has increased significantly. The recession has also driven structural reforms, and affected the priority given to public policies. The purpose of this paper is to analyse how austerity impacts health in Europe and better understand the response of European health systems to the financial crisis. The current economic climate, while challenging, presents an opportunity for reforming and restructuring health promotion actions. More innovative approaches to health should be developed by health professionals and by those responsible for health management. In addition, scientists and experts in public health should promote evidence-based approaches to economic and public health recovery by analyzing the present economic downturn and previous crisis. However, it is governance and leadership that will mostly determine how well health systems are prepared to face the crisis and find ways to mitigate its effects