Price and volume measures for health Overview of EU legal requirements 26-27 May 2005

Features of health services Delivered both as market and non-market output -> requires consistent methods for both Quality issues similar for market and non-market output Individual services, wide variety (different types of hospitals, general practitioners, specialist, dentist, social work) Different funding systems in different countries -> can determine data availability 26-27 May 2005

Definition of health care output “The quantity of health care received by patients, adjusted to allow for the qualities of the services provided, for each type of health care.” Quantity of health care received can be measured by numbers of complete treatments Stratification by type of health care is important to apply proper cost weights 26-27 May 2005

Complete treatments Treatment = bundle of complementary services (medical, paramedical, laboratory, radiological, etc.) One treatment can be delivered by a combination of units in different NACE classes -> gives practical problem of measurement More narrow concept of treatment used 26-27 May 2005

Diagnosis Related Groups (DRGs) Used in hospital administrations in many countries Classify hospital stays into groups that are Medically meaningful Homogeneous as regards resource use Always very detailed (hundreds of groups) 26-27 May 2005

Quality changes Detailed DRGs can capture changes in the treatment mix (eg move to better types of treatments) Capturing and evaluating quality changes in individual treatments is very difficult 26-27 May 2005

A, B and C methods Handbook gives detailed description of A/B/C classification for different services. In general: Output methods are A when quality-adjusted. When not (sufficiently) quality-adjusted, then B. Input methods are C. For market output, if prices are available, they are A or B. 26-27 May 2005

General hospital services A method is the use of detailed cost-weighted quality-adjusted DRGs. Non quality-adjusted DRGs is B. Discharges (using ICD classification) is B when detailed enough. For psychiatric hospitals, rehabilitation centres, nursing services: number of occupant-days can be B (or even A when service provided is really homogeneous) 26-27 May 2005

Medical practice services General practitioners: one visit = one treatment -> number of consultations can be A or B method (depending on stratification by type of treatment and quality-adjustments) Medical specialists: one treatment = series of visits -> take number of first visits. Breakdown by types of specialist indispensible for a B method. (Same for dentists) 26-27 May 2005

Social work With accommodation: Without accommodation: A: number of occupant days by type of institution and adjusted for quality B: same without breakdown by institution or adjustment for quality Without accommodation: A or B: number of persons receiving care 26-27 May 2005