1. Payment and Funding Mechanisms
October 10, 2000

2. 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

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

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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

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

13. 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

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