Zeynep Or1,2, Kosta Shatrov3,4, Anne Penneau1,2, Walter Wodchis5,6,7, Olukorede Abiona8, Carl Rudolf Blankart3,4,9, Nicholas Bowden10, Enrique Bernal-Delgado11, Hannah Knight12, Luca Lorenzoni13, Alberto Marino13,14, Irene Papanicolas14, Kristen Riley15, Leila Pellet1, Francisco Estupiñán-Romero11, Kees van Gool8, Jose F Figueroa15. 1. Institute for Research and Information in Health Economics (IRDES), Paris, France. 2. Department of Economics (LEDa), University Dauphine PSL, Paris, France. 3. KPM Center for Public Management, University of Bern, Bern, Switzerland. 4. Swiss Institute of Translational and Entrepreneurial Medicine, Bern, Switzerland. 5. Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. 6. Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada. 7. ICES, Toronto, Ontario, Canada. 8. Centre for Health Economics Research and Evaluation (CHERE), University of Technology, Sydney, New South Wales, Australia. 9. Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany. 10. Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 11. Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain. 12. The Health Foundation, London, UK. 13. Organisation for Economic Co-operation and Development (OECD), Paris, France. 14. Department of Health Policy, London School of Economics, London, UK. 15. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Abstract
OBJECTIVE: To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. DATA SOURCES: Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States. DATA COLLECTION METHODS: Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016. STUDY DESIGN: We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures. PRINCIPAL FINDINGS: In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97). CONCLUSIONS: Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.
OBJECTIVE: To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. DATA SOURCES: Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States. DATA COLLECTION METHODS: Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016. STUDY DESIGN: We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures. PRINCIPAL FINDINGS: In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97). CONCLUSIONS: Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.
Authors: Zeynep Or; Kosta Shatrov; Anne Penneau; Walter Wodchis; Olukorede Abiona; Carl Rudolf Blankart; Nicholas Bowden; Enrique Bernal-Delgado; Hannah Knight; Luca Lorenzoni; Alberto Marino; Irene Papanicolas; Kristen Riley; Leila Pellet; Francisco Estupiñán-Romero; Kees van Gool; Jose F Figueroa Journal: Health Serv Res Date: 2021-08-19 Impact factor: 3.402
Authors: Zeynep Or; Kosta Shatrov; Anne Penneau; Walter Wodchis; Olukorede Abiona; Carl Rudolf Blankart; Nicholas Bowden; Enrique Bernal-Delgado; Hannah Knight; Luca Lorenzoni; Alberto Marino; Irene Papanicolas; Kristen Riley; Leila Pellet; Francisco Estupiñán-Romero; Kees van Gool; Jose F Figueroa Journal: Health Serv Res Date: 2021-08-19 Impact factor: 3.402