Payment and Funding Mechanisms October 10, 2000

A continuation of the previous discussion How is X paid for? by whom? with what associated incentives/disincentives? what difference did it make? Columbia University School of Nursing M6920, Spring 2000

Cost and outcomes efficacy effectiveness efficiency Columbia University School of Nursing M6920, Spring 2000

Efficacy Does the therapy work in well-controlled clinical trials Is this worth doing at all? Columbia University School of Nursing M6920, Spring 2000

Effectiveness Does the therapy work in routine care? Can it be carried out by ordinary practitioners? Usually a smaller benefit than demonstrated in efficacy study Columbia University School of Nursing M6920, Spring 2000

Efficiency Is the cost of doing the therapy worth the financial and other costs? Based on cost/effectiveness study Cost calculated per unit of health obtained year of survival hospitalization avoided Columbia University School of Nursing M6920, Spring 2000

Cost benefit studies done to compare net cost of interventions into different problems can also be identified as cost utility studies requires use of QALY or DALY for comparative purposes Columbia University School of Nursing M6920, Spring 2000

Major issues in cost benefit studies defining the scope of the question (all disease, all populations, geography) deciding perspective gold standard requires societal perspective Columbia University School of Nursing M6920, Spring 2000

More issues deciding the time interval for analysis filling in data blanks literature expert opinion Columbia University School of Nursing M6920, Spring 2000

Cassidy et al Policy change creates natural experiment in effect of paymen Existing claims data base Outcome measure: length of case Conclusion: decreased incidence Columbia University School of Nursing M6920, Spring 2000

Di Matteo Past studies: variation is due to GDP Pooled time-series cross section regression analysis Ratios by province over time Key factors real per capita income proportion over 65 real federal $$ transfer Columbia University School of Nursing M6920, Spring 2000

Di Matteo Design clarity? Data sources? Discussion? Columbia University School of Nursing M6920, Spring 2000

Broyles et al Risk adjustment is major challenge Model building research assumption that risks in population govern use/cost Comparison of two approaches reference case vs. adjusted Columbia University School of Nursing M6920, Spring 2000

Feder et al. Overview of knowledge What questions are raised? Columbia University School of Nursing M6920, Spring 2000