Introducing activity-based financing: a review of experience in Australia, Denmark, Norway and Sweden

We review and evaluate the international literature on activity-based funding of health services, focussing especially on experience in Australia (Victoria), Denmark, Norway and Sweden. In evaluating this literature we summarise the differences and pros and cons of three different funding arrangements, namely cost-based reimbursement, global budgeting and activity-based financing. The institutional structures of the four jurisdictions that are the main focus of the review are described, and an outline is provided about how activity-based funding has been introduced in each. We then turn to the mechanics of activity-based funding and discuss in detail how patients are classified, how prices are set and how other services are funded. Although concentrating on the four jurisdictions, we draw on wider international experience to inform this discussion. We review evidence of the impact of activity-based funding in the four jurisdictions on efficiency, activity rates, waiting times, quality and overall expenditure. Finally we conclude with a brief commentary of some of the challenges that would have to be faced if implementing activity-based funding.

Essays on Diagnosis Related Groups (DRGs) : Empirical estimation of the impact of a more accurate measurement of outpatient production on hospital efficiency and productivity

Ei ilmesty julkisessa verkoss

Opetuksen ja tutkimuksen aiheuttamat kustannukset sairaaloille vuosina 2004-2006

Verkkoversion ISBN 978-951-33-2232-8, ISSN 1795-810

Estimation of hospital efficiency--Do different definitions and casemix measures for hospital output affect the results?

Objectives Hospital efficiency has been the subject of numerous health economics studies, but there is little evidence on how the chosen output and casemix measures affect the efficiency results. The aim of this study is to examine the robustness of efficiency results due to these factors. Comparison is made between activities and episode output measures, and two different output grouping systems (Classic and FullDRG).Methods Non-parametric data envelopment analysis is used as an analysis technique. The data consist of all public acute care hospitals in Finland in 2005 (n = 40).Results Efficiency estimates were not found to be highly sensitive to the choice between episode and activity descriptions of output, but more so to the choice of DRG grouping system. Estimates are most sensitive to scale assumptions, with evidence of decreasing returns to scale in larger hospitals.Conclusions Episode measures are generally to be preferred to activity measures because these better capture the patient pathway, while FullDRGs are preferred to Classic DRGs particularly because of the better description of outpatient output in the former grouping system. Attention should be paid to reducing the extent of scale inefficiency in Finland.Hospitals Efficiency Outcome assessment

Introducing Activity-Based Financing: A Review of Experience in Australia,

CHE Discussion Papers (DPs) began publication in 1983 as a means of making current research material more widely available to health economists and other potential users. So as to speed up the dissemination process, papers were originally published by CHE and distributed by post to a worldwide readership. The new CHE Research Paper series takes over that function and provides access to current research output via web-based publication, although hard copy will continue to be available (but subject to charge). Acknowledgements This paper is based on a report commissioned by the Department of Health and Social Services in Wales. Particular thanks are due to Mark Bowling, Jeff Buggle, Steve Elliot and Christine Miles. The usual caveat applies. Disclaimer Papers published in the CHE Research Paper (RP) series are intended as a contribution to current research. Work and ideas reported in RPs may not always represent the final position and as such may sometimes need to be treated as work in progress. The material and views expressed in RPs are solely those of the authors and should not be interpreted as representing the collective views of CHE research staff or their research funders. Further copies Copies of this paper are freely available to download from the CHE websit

Kannattaako tupakoinnin lopettaminen? : Tupakoinnista aiheutuvien eliniänaikaisten hoitokustannusten ja tupakoinnin lopettamisesta syntyvien säästöjen arviointia

VerkkoISSN 1795-821

Opetuksen ja tutkimuksen aiheuttamat kustannukset sairaaloille vuosina 1998-2002

EVO - yliopistosairaaloiden erityisvaltionosuu