Wednesday, August 11, 2010

[EQ] Hospital capacity planning: from measuring stocks to modelling flows

Hospital capacity planning: from measuring stocks to modelling flows

Bernd Rechel ^a, Stephen Wright ^b, James Barlow ^c & Martin McKee ^aa. European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London England.

b. European Centre for Health Assets and Architecture, Utrecht, Netherlands

c. Health and Care Infrastructure Research and Innovation Centre, Imperial College Business School, London, England.
Bulletin of the World Health Organization 2010;88:632-636. doi: 10.2471/BLT.09.073361
Volume 88, Number 8, August 2010, 561-640

Available online at: http://bit.ly/cB0hju

“……….Although revenue for hospital services in many developed countries is increasingly based on measures of activity such as diagnosis-related groups, hospital capacity planning remains dominated by “bed numbers”.¹ A review of international practice found that bed capacity continues to be the preferred unit for planning hospital care in Finland, Germany, Italy, New Zealand and most Canadian provinces. Of the countries included in the review, only England and France were moving towards planning based on service volume and activity.^2,3 Bed occupancy and the ratio of beds per population remain predominant metrics in hospital capacity planning.^4–6

There are several problems associated with this approach. Most importantly, bed numbers or bed occupancy do not provide a good measure of the services provided inside hospitals, given the wide variation in case mix and thus treatment costs of those occupying the beds,⁴ nor are they suitable for predicting future demand.⁷ The measure implies that the bed is the core piece of capital stock in the hospital, constraining the performance of the other assets around it. The near universal trend towards growing numbers of day cases and shorter lengths of hospital stay further invalidates beds as a measure of capacity.

The continued use of “bed numbers” also fails to consider the trade-offs and complementarities from investing in different types of health capital. Thus, while bed numbers have the benefit of convenience, as they are one of the few indices of hospital capacity that are routinely collected, there is a growing recognition of the intrinsic limits of this measure….”

http://www.who.int/bulletin/volumes/88/8/09-073361/en/index.html

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[EQ] Outreach strategies for expanding health insurance coverage in children

[Intervention Review]

Outreach strategies for expanding health insurance coverage in children

Qingyue Meng¹, Beibei Yuan¹, Liying Jia¹, Jian Wang¹, Paul Garner²
¹Center for Health Management and Policy, Shandong University, Jinan, China. ²International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD008194. DOI: 10.1002/14651858.CD008194.pub2.
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Available at: http://bit.ly/bLqvl8

Health insurance has the potential to improve access to health care and protect people from healthcare costs when they are ill. However, coverage is often low, particularly in people most in need of protection.

Objectives

To assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes.

Search strategy

We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (The Cochrane Library 2009, Issue 2), PubMed (January 1951 to January 2010), EMBASE (January 1966 to April 2009), PsycINFO (January 1967 to April 2009) and other relevant databases and websites. In addition, we searched the reference lists of included studies and relevant reviews, and carried out a citation search for included studies to find more potentially relevant studies.

Selection criteria

Randomised controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series which evaluated the effects of outreach strategies on increasing health insurance coverage for children. We defined outreach strategies as measures to improve the implementation of existing health insurance to enrol more eligible populations. This included increasing awareness of schemes, modifying enrolment, improving management and organis ation of insurance schemes, and mixed strategies.

Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias . We narratively summari sed the data.

Main results

We included two studies, both from the United States. One randomised controlled trial study with a low risk of bias showed that community- based case managers who provided health insurance information, application support, and negotiated with the insurer were effective in enrolling and maintaining enrolment of Latino American children into health insurance schemes (n = 257). The second quasi-randomised controlled trial, with an unclear risk of bias (n = 223), indicated that handing out insurance application materials in hospital emergenc y departments can increase enrolment of children into health insurance.

Authors' conclusions

The two studies included in this review provide evidence that in the US providing health insurance information and application assistance, and handing out application materials in hospital emergency departments can probably both improve insurance coverage of children. Further studies evaluating the effectiveness of different outreach strategies for expanding health insurance coverage of children in different countries are needed, with careful attention given to study design.

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[EQ] Making chronic conditions count : hypertension, stroke, coronary heart disease, diabetes : a systematic approach

Making Chronic Conditions Count:
Hypertension, Stroke, Coronary Heart Disease, Diabetes.

A systematic approach to estimating and forecasting population prevalence on the island of Ireland.

The Institute of Public Health in Ireland, 2010.

Prepared by: Kevin P Balanda, Steve Barron, Lorraine Fahy, Aisling McLaughlin

Available online PDF [88p.] at: http://bit.ly/9ikccD

Technical Supplement PDF [28p.] at: http://bit.ly/cwLVMK :

“…..This report contains estimates and forecasts of the population prevalence1 of four chronic conditions: hypertension, coronary heart disease (angina and heart attack), stroke and diabetes (Type 1 and Type 2 combined). It shows how their prevalence varies across the island and what change is expected between 2007, 2015 and 2020.

Chronic conditions are responsible for a significant proportion of early deaths. They reduce quality of life in many of the adults living with them, represent substantial financial costs to patients and the health and social care system, and cause a significant loss of productivity to the economy.

Although the population is living longer, chronic conditions have reduced the quality of the extra years that have been gained. There is evidence in the Republic of Ireland, the United Kingdom and Europe, that over recent decades, while life expectancy has increased, healthy life expectancy has not kept up (www.ehemu.eu).

The burden of conditions is expected to rise because our population will grow, it will age and some risk factors such as obesity will become more common. Unless we address this growing burden we may continue to add more years to our lives without adding more life to those years.

Chronic conditions occur more frequently among the poor and vulnerable. A range of interrelated factors including the social determinants of health such as poverty, unemployment and the environment, smoking, alcohol consumption, diet and physical activity are established risk factors for chronic conditions. These risk factors are distributed unevenly across society….”

Contents

Foreword

Executive Summary

1. Introduction 15

2. Estimating and Forecasting Prevalence

3. Hypertension

4. Angina and Heart Attack (CHD)

5. Stroke

6. Diabetes

7. Recommendations

References

Technical Supplement:

Contents

INTRODUCTION

HOW THE MODELS WORK

STEP 1: Estimating risk

STEP 2: Estimating and forecasting the distribution of risk

STEP 3: Obtaining estimated and forecasted prevalence

REFERENCES

APPENDIX 1: Risk factors included in the hypertension, coronary heart disease and stroke models

APPENDIX 2: Validation of hypertension, coronary heart disease and stroke models

APPENDIX 3: Deprivation measures used from Northern Ireland and the Republic of Ireland

http://www.inispho.org/files/file/Making%20Chronic%20Conditions.pdf

http://www.inispho.org/files/file/Making%20Chronic%20Conditions%20Count%20Tech%20Supp.pdf

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