Sosiaali- ja terveydenhuollon tarvetekijät ja valtionosuusjärjestelmän uudistaminen

Raportissa esitellään tutkimukseen perustuva ehdotus uusiksi sosiaali- ja terveydenhuollon valtionosuuskriteereiksi. Samalla raportti tarjoaa kattavan kuvan Suomen valtionosuusjärjestelmän uudistamistarpeista ja uudistamisen mahdollisista periaatteista. Tutkimuksessa analysoitiin, mitkä yksilötason tekijät vaikuttavat terveyden-, vanhusten- ja sosiaalihuollon palveluiden käyttöön ja siitä johtuviin kustannuksiin. Tulosten perusteella määriteltiin, miten kuntakohtaiset tarvekertoimet voidaan laskea. Tutkimustulokset osoittavat, että nykyisen valtionosuusjärjestelmän ikäpainotteiset kriteerit kuvaavat heikosti kustannusten jakautumista kuntien välillä. Kriteereitä parantaa huomattavasti sairastavuuden lisääminen malliin. Lisäksi henkilön sosioekonomiset ominaisuudet ovat tärkeitä palveluiden käyttöä kuvaavia tekijöitä, jotka tulisi ottaa huomioon valtionosuuksia laskettaessa. Raportti toimii tutkimustulosten esittelyn lisäksi aloitteena perusteellisemmalle keskustelulle oikeudenmukaisesta ja tehokkaasta valtionosuusjärjestelmästä. Raportti on suunnattu kuntien sosiaali- ja terveyssektorin johtajille ja kehittäjille sekä sosiaalipolitiikan ja terveystaloustieteen tutkijoille

Pathways leading to coronary revascularisation among patients with diabetes in Finland: a longitudinal register-based study

<p>Abstract</p> <p>Background</p> <p>Chronic conditions such as coronary heart disease (CHD) challenge health care to provide systematic and long-lasting disease management. In this study of patients who were revascularized, we examine whether treatment pathways leading to coronary revascularisation differ between patients with and without diabetes.</p> <p>Methods</p> <p>This retrospective, nationwide register-based study in Finland in 1998-2007 describes temporal trends in the proportions of 1) revascularisations performed at the first treatment period, and 2) suboptimal treatment pathways to revascularisations, i.e. pathways containing several cardiac emergency hospitalisations. Differences between patient groups were examined using a logistic regression model adjusting for age, comorbidity, and region.</p> <p>Results</p> <p>Among patients who underwent revascularisation, upward trends were found in the proportions of revascularisations performed during first hospital admission: among men with CHD alone, the percentages were 28% in 1998 and 77% in 2007; among men with insulin-dependent diabetes (IDD) they were 16% vs. 58% for the respective years; and among men with non-insulin dependent diabetes (NIDD) they were 25% vs. 69%, respectively. Among women the percentages were for non-diabetic group 32% vs. 77%; for IDD group 36% vs. 64%; and for NIDD group 33% vs. 73% for the respective years. Patients with diabetes were less likely to undergo revascularisation during the first hospital admission, in 2005-2007, the odds ratio (OR) for IDD among men was 0.52 (95% confidence interval 0.42-0.64) and for NIDD among men it was 0.79 (95% CI 0.73-0.86) compared to patients with CHD alone. The respective ORs among women were 0.59 (95% CI 0.44-0.78), and 0.83 (95% CI 0.74-0.93).</p> <p>Conclusions</p> <p>Treatment practices changed substantially during the study period to favour performing revascularisation during the first hospital admission. The large increase in coronary angioplasty operations is likely to be an important factor behind these changes. However, fewer operations are performed during the first CHD hospitalisation of diabetic patients who undergo coronary revascularisation and they experience more often emergency hospital admissions before the operation than patients without diabetes. To avoid adverse cardiac events, more attention is needed in managing diabetic CHD patients' referral pathways to revascularisation.</p

Hospital productivity and the Norwegian ownership reform – A Nordic comparative study

In a period where decentralisation seemed to be the prominent trend, Norway in 2002 chose to re-centralise the hospital sector. The reform had three main aims; cost control, efficiency and reduced waiting times. This study investigates whether the hospital reform has improved hospital productivity using the other four major Nordic countries as controls. Hospital productivity measures are obtained using data envelopment analysis (DEA) on a comparable dataset of 728 Nordic hospitals in the period 1999 to 2004. First a common reference frontier is established for the four countries, enveloping the technologies of each of the countries and years. Bootstrapping techniques are applied to the obtained productivity estimates to assess uncertainty and correct for bias. Second, these are regressed on a set of explanatory variables in order to separate the effect of the hospital reform from the effects of other structural, financial and organizational variables. A fixed hospital effect model is used, as random effects and OLS specifications are rejected. Robustness is examined through alternate model specifications, including stochastic frontier analysis (SFA). The SFA approach in performed using the Battese & Coelli (1995) one stage procedure where the inefficiency term is estimated as a function of the set of explanatory variables used in the second stage in the DEA approach. Results indicate that the hospital reform in Norway seems to have improved the level of productivity in the magnitude of approximately 4 % or more. While there are small or contradictory estimates of the effects of case mix and activity based financing, the length of stay is clearly negatively associated with estimated productivity. Results are robust to choice of efficiency estimation technique and various definition of when the reform effect takes place.Efficiency; productivity; DEA; SFA; hospitals