Fakultät für Gesundheitswissenschaften Gesundheitsökonomie und Gesundheitsmanagement Universität Bielefeld WP 3.1 and WP 4.1: Macrocost

Universität Bielefeld Folie 2 Gesundheitsökonomie und Gesundheitsmanagement Objective of WP3.1 / WP4.1 The objective of WPs 3.1 and 4.1 is to be able to measure costs/health expenditures at a macro- level Those costs should be comparable between the countries or at least between the 4 models developed in WP2 Therefore some kind of comparator must be chosen

Universität Bielefeld Folie 3 Gesundheitsökonomie und Gesundheitsmanagement Steps undertaken so far Initial contact to participants via questionnaire about basic data sources Systematic Review (Medline, NICE EED) First evaluation of available data sources identified through the questionnaire

Universität Bielefeld Folie 4 Gesundheitsökonomie und Gesundheitsmanagement Results: Systematic Review After exclusion by title: 8 studies remaining 4 studies reviewed so far Only feasible approach: –Starfield et al. (2002): Ranking of countries by total health expenditure. Ranking of different PHC-related parameters and scores. Correlation between ranks.

Universität Bielefeld Folie 5 Gesundheitsökonomie und Gesundheitsmanagement Problems of different degree‘s of data-accessibility High degree of data complexity Problem: Identification of PC-relevant activities Low degree of data complexity Problem: Identification of the proportion of costs relating to PC Italy* EstoniaFinnland Lithuania Hungary Germany Spain* PHC Cost * Patient-level data available for certain region

Universität Bielefeld Folie 6 Gesundheitsökonomie und Gesundheitsmanagement Solution?! Search for a least common comparator adjusted for country-specific data, e.g. (following Donabedian) some structural parameter Basecase including comparison of all countries/models containing the least number of activities regarded as PHC (A1, A5, B3, C4, D27, E2) Further, more detailed analyses wherever possible and feasible

Universität Bielefeld Folie 7 Gesundheitsökonomie und Gesundheitsmanagement Solution?! Proposal: –Low Degree of data complexity-countries: Estimation of proportion of identified activities (via published evidence or expert opinion) –High degree of data complexity-countries: Aggregation of patient-level data for the identified activities

Universität Bielefeld Folie 8 Gesundheitsökonomie und Gesundheitsmanagement PHC cost dataCommon HC cost data Patient -levelAggregatedPatient-levelAggregated (I)Aggregate Data for core activities (II)Calculate proportion of cost for professions Split data by time of professionals spent for core activities via expert opinion/literature (I)Aggregate Data for core activities (II)Calculate proportion of cost for professions Split data by time of professionals spent for core activities via expert opinion/literature Cost per profession Cost per capita Direct adjustment: -Time differences -Purchasing power Indirect adjustment: -Age structure Concrete Procedure

Universität Bielefeld Folie 9 Gesundheitsökonomie und Gesundheitsmanagement Final table Cost per Capita Core activities Further analyses, e. g. other activities Country or model