24 de febr. 2018

Performance culture in hospitals: if you are good in one dimension you'll probably will be good in the rest

Nils Gutacker and Andrew Street using a sample of 95955 patients treated in 252 hospitals during  april 2009 and march 2012 on hip replacement surgery in the English National Health Service, explored the performance of the hospitals. They use four performance indicators: 1) Post operative health status (post OHS); 2) Length of stay (LOS); 3) Waiting time >18 weeks; 4) 28-day emergency readmission.

Using a multidimensional model and a dominance criteria they show us that there are a significance correlation between them.

  • Hospitals with shorter LOS also realise better post operative health status (the fast track or enhanced recovery).
  • Hospitals that have a lower proportion of patients waiting more than 18 weeks to be admitted also have a shorter LOS
  • Hospitals with better post OHS also tend to have a lower proportion of patients waiting for more 18 weeks
  • The emergency readmission within 28 days has a negative impact on health status
They also classified the hospitals in three categories: dominant (perform well), dominated (perform poorly) and non-comparable in overall performance effects: All dominant hospitals are private Independent Sector Treatment Centres (ISTCs), and all dominated hospitals are public NHS.
  • Volume outcome are not important in explaining overall performance differences between them. 
  • Dominant providers operates in a more competitive markets (in a quality competition in-price regulated market). 
  • Dominant providers have economies of scope. Good overall performance is associated with more concentrated delivery system. 
  • ISTCs don't cherry pick healthier cases to treat or “dump” complex cases back into the NHS.
Providers to perform better in one dimension have an excellent performance on another. This means that some providers have a better performance culture than others and this are better for patients.

Access to the article (pdf): Multidimensional performance assessment of public sector organisations using dominance criteria (Health Economics 2017)

photo: Light: (*) Photosolde.

11 de febr. 2018

Alan Maynard arrived at York when I was born

Alan Maynard was the greatest influencer in the field of health economics.

Alan arrived at York as a graduate student in economics in 1967, when I was born. In 1978 he created York’s MSc in health economics, and in 1983 he founded the Centre for Health Economics (CHE), where he was Director until 1995. CHE has had a major influence on health policy and the development of health economics, and continues to flourish.

He was founding editor of Health Economics, now a leading journal in the field, and later had a hand in creating two other thriving institutions: the York Health Economics Consortium and the Centre for Reviews and Dissemination.

Maynard matters. Critical thinking on health policy
This edited volume is a book with two parts:

Part One of the book consists of a set of short pieces written by Alan’s colleagues, celebrating his contributions to different areas of academic and public life. Part Two contains a selection of Alan’s work.
As Tony Culyer says you will meet seven Maynards in these pages:

  1. The health economics pioneer: cost-effectiveness studies, health service inequalities and economics of mental health, an analytical approach to health service design and management.
  2. The high class journalist: Innumerable think pieces in the Health Service Journal. Often scathing, often ironic, often right, NEVER dull.
  3. The high class academic: Founding editor of a great journal: Health Economics.
  4. The policy wonk: His impact on family doctor fund-holding, the creation of NICE, workforce contracting.
  5. The academic manager: Founding director of the Centre for Health Economics
  6. The teacher: Insightful, amusing (often hilarious) but wise and caring too. Never without a box of Kleenex for those who found the going tough.
  7. The NHS chair: York Hospital NHS Foundation Trust for 12 years, Vale of York NHS Commissioning Group 2012-15.

photos: York daffodils. Heslington Hall by W. Monkhouse (1860)