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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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