Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice

Journal Article


Abstract


  • Evidence based medicine supports net benefit maximising therapies and strategies in processes of health

    technology assessment (HTA) for reimbursement and subsidy decisions internationally. However,

    translation of evidence based medicine to practice is impeded by efficiency measures such as cost per

    case-mix adjusted separation in hospitals, which ignore health effects of care.

    In this paper we identify a correspondence method that allows quality variables under control of

    providers to be incorporated in efficiency measures consistent with maximising net benefit. Including

    effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or

    reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is

    shown to enable efficiency measures consistent with maximising net benefit under a one to one

    correspondence. The method combines advantages of radial properties with an appropriate objective of

    maximising net benefit to overcome problems of inappropriate objectives implicit with alternative

    methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in

    morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in

    undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their

    costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying

    correspondence method are also shown to provide a robust framework for preventing cost-shifting and

    cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and

    risk adjustment where these conditions are not satisfied.

    Comparison on the cost-disutility plane has previously been shown to have distinct advantages in

    comparing multiple strategies in HTA, which this paper naturally extends to a robust method and

    framework for comparing efficiency of health care providers in practice. Consequently, the proposed

    approach provides a missing link between HTA and practice, to allow active incentives for evidence based

    net benefit maximisation in practice.

Publication Date


  • 2013

Citation


  • S. Eckermann & T. Coelli, "Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice", Social Science and Medicine 76 (2013) 159-168.

Scopus Eid


  • 2-s2.0-84870868852

Ro Metadata Url


  • http://ro.uow.edu.au/ahsri/170

Number Of Pages


  • 9

Start Page


  • 159

End Page


  • 168

Volume


  • 76

Abstract


  • Evidence based medicine supports net benefit maximising therapies and strategies in processes of health

    technology assessment (HTA) for reimbursement and subsidy decisions internationally. However,

    translation of evidence based medicine to practice is impeded by efficiency measures such as cost per

    case-mix adjusted separation in hospitals, which ignore health effects of care.

    In this paper we identify a correspondence method that allows quality variables under control of

    providers to be incorporated in efficiency measures consistent with maximising net benefit. Including

    effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or

    reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is

    shown to enable efficiency measures consistent with maximising net benefit under a one to one

    correspondence. The method combines advantages of radial properties with an appropriate objective of

    maximising net benefit to overcome problems of inappropriate objectives implicit with alternative

    methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in

    morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in

    undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their

    costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying

    correspondence method are also shown to provide a robust framework for preventing cost-shifting and

    cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and

    risk adjustment where these conditions are not satisfied.

    Comparison on the cost-disutility plane has previously been shown to have distinct advantages in

    comparing multiple strategies in HTA, which this paper naturally extends to a robust method and

    framework for comparing efficiency of health care providers in practice. Consequently, the proposed

    approach provides a missing link between HTA and practice, to allow active incentives for evidence based

    net benefit maximisation in practice.

Publication Date


  • 2013

Citation


  • S. Eckermann & T. Coelli, "Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice", Social Science and Medicine 76 (2013) 159-168.

Scopus Eid


  • 2-s2.0-84870868852

Ro Metadata Url


  • http://ro.uow.edu.au/ahsri/170

Number Of Pages


  • 9

Start Page


  • 159

End Page


  • 168

Volume


  • 76