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ACG case-mix and needs-based resource allocation in primary health care. Assoc. Professor Anders Halling, Department of Clinical Sciences Malmö General Practice, Lund University Competence Center Blekinge Wämö Center 371 81 Karlskrona. anders.halling@ltblekinge.se. Background.

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acg case mix and needs based resource allocation in primary health care

ACG case-mixand needs-based resource allocation in primary health care

Assoc. Professor Anders Halling,

Department of Clinical Sciences Malmö

General Practice, Lund University

Competence Center Blekinge

Wämö Center

371 81 Karlskrona

anders.halling@ltblekinge.se

background
Background
  • What do we do in primary care ?
  • What results do we achieve with the care we provide ?
  • In a future with different types of caregivers it is important to be able to monitor results.
  • How can resources in primary care be allocated on a needs base?
slide3
There is a need for analysis of what PHC does and what results are achieved in order to meet the new challanges of an ageing population!
slide4
Aim
  • To briefly describe ACG Case-Mix: a measure of comorbidity.
  • To briefly describe how health care cost on the individual level can be estimated using activity based costing (ABC-calculation).
  • To describe how ACG Case-mix and ABC-calculation can be combined to form a needs based primary health care budget.
where does the patient receive care need for coordinated care for patients with comorbidities
Where does the patient receive care?-need for coordinated care for patients with comorbidities

%

90.9%

Primary- and hospital care

48%

Primary health care alone

9.3%

1.3%

Degree of Comorbidity

framework of the acg case mix system
Framework of the ACG Case-mix System

Diagnosis Codes

  • Duration
  • Severity
  • Diagnostic certainty
  • Ethiology
  • Need for specialised care

Adjusted Diagnosis Groups (ADGs)

JANUARY DECEMBER

(ACGs)-Adjusted Clinical Groups

validation of acg case mix in swedish phc
Validation of ACG Case-mix in Swedish PHC
  • In Sweden health care is funded at the population level, no information on cost at the individual level is available.
  • In an attempt to validate the ACG Case-mix system we used used Rx as a proxy BMC Public Health 2006, 6:171
  • Cost per patient (CPP) calculated using activity based costing (ABC)
slide11

Activity based costing

Patients

Budget

Resources

Activities

validation of acg case mix with total primary health care cost calculated with abc calculation
Validation of ACG Case-mix with total primary health care cost calculated with ABC-calculation

Age

Sex

Primary health care district

Patients

Budget

Resources

Activities

CPP

slide13

Mean primary health care cost of for inhabitants in Blekinge county

in each resource utilization band (RUB)

RUB Year

S kr

slide15

Comorbidity and primary health care cost of in Blekinge county

60.6 %

7.5 %

0.1

7.5 %

9.7 %

1.3

19.9 %

33.6 %

1.7

11.1 %

3.8

42.2 %

5.7 %

8.1

0.7 %

0.1 %

1.4 %

14.0

RUB Year

modeling comorbidity acg case mix and cost cpp for primary health care
Modeling comorbidity (ACG Case-mix) and cost (CPP) for primary health care.
  • Linear regression model
  • Dependent variable :CPP: ABC calculated cost of primary health care year 2005 of patients listed to county council owned primary health care centres in Blekinge, transformed variable.
  • Independent variable:
  • Age,sex, primary health care district
  • ACG Case-Mix: primary health care year 2005
model for primary health care cost year 2005
Model for primary health care cost year 2005
  • Constant: 98 kr
  • Sex: 13 kr
  • Age: 20-39 år: 1 kr, 40-79 år: 66 kr, 80- år: 1272 kr
  • Comorbidity: RUB 1: 912kr, RUB 2: 1275kr, RUB 3: 3014 kr, RUB 4: 6626kr, RUB 5: 10774kr.
  • Primary health care district: 2: -19.36 kr 3: -6.05 kr 4: 0.28 kr 5: -8.40 kr 6: -0.98 kr

RUB: resource utilization band

slide18
The coefficient of determination R2the proportion of variability in a data set that is accounted for by a statistical model

comorbidity

73 %

R2

primary health care district

age

27 %

sex

Model

resource allocation in primary health care blekinge year 2005 and adjusted for comorbidity
Resource allocation in primary health care Blekinge year 2005 … and adjusted for comorbidity
slide20

Resource allocation in primary health care (PHC) Blekinge 2005

PHC district 1

PHC district 2

PHC district 3

PHC district 4

PHC district 5

PHC district 6

0 20 40 60 80

million kr

it does however not tell about
It does however not tell about…
  • Which results were achieved?
  • How large part of the patient´s healthcare need that was fulfilled in primary health care.
degree of coverage
Degree of coverage

Primary health care

ACG Case-mix

CPP

Hospital care

background24
Background
  • In a socialised health care system the government has responsibility to provide good quality healthcare that fulfills the population´s health care needs.
  • The government is also responsible to monitor if the healthcare resources are used cost-efficiently.
  • The ability of the government´s ability to monitor healthcare provider performance has been limited.
slide25
Aim
  • To study if comorbidity, age and sex is of importance when patient´s decide to relist from a private- to a state owned healthcare center in Blekinge, Sweden.
slide26

Method

Primary care diagnoses

ACG Case-Mix, comorbidity

january 2005 december 2005

slide27

Method

1-Oct-2005

1-Oct-2006

Privately owned

healthcare centre

County Council Owned

healthcare centre

slide28

Metod

1-Oct-2005

4066

480 (12%)

3273 (80%)

1-Oct-2006

County Council Owned

healthcare centre

Privately owned

healthcare centre