scholarly journals Patient-level information and costing systems (PLICSs): a mixed-methods study of current practice and future potential for the NHS health economy

2016 ◽  
Vol 4 (31) ◽  
pp. 1-156 ◽  
Author(s):  
Sue Llewellyn ◽  
Naomi Chambers ◽  
Sheila Ellwood ◽  
Christos Begkos ◽  
Chris Wood
Keyword(s):  
Health Care ◽  
Community Services ◽  
Health Economy ◽  
Service Line ◽  
Health And Social Care ◽  
Care Models ◽  
Level Information ◽  
Foundation Trusts ◽  
The Cost ◽  
Cost Object

BackgroundTraditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in patient-level information and costing systems (PLICSs). Monitor (the economic regulator for health care) proposes that PLICS data will now form the basis for mandatory prices for health-care services across all care settings.ObjectiveOur main aim was to investigate the use of PLICSs.MethodsWe surveyed all English foundation trusts and NHS trusts, and undertook four case studies of foundation trusts. Three trusts were generalist and one was specialist. We also surveyed commissioning support units to explore the potential for PLICSs in commissioning.FindingsThe most significant use of PLICSs was cost improvement within the trusts. There was only modest utilisation of PLICSs to allocate resources across services and settings. We found that trusts had separate reporting systems for costs and clinical outcomes, engendering little use for PLICSs to link cost with quality. Although there was significant potential for PLICSs in commissioning, 74% of survey respondents at trusts considered their PLICS data to be commercially sensitive and only 5% shared the data with commissioners. The use of PLICSs in community services was, generally, embryonic because of the absence of units of health care for which payment can be made, service definitions and robust data collection systems. The lack of PLICS data for community services, allied with the commercial sensitivity issue, resulted in little PLICS presence in collaborative cross-organisational initiatives, whether between trusts or across acute and community services. PLICS data relate to activities along the patient pathway. Such costs make sense to clinicians. We found that PLICSs had created greater clinical engagement in resource management despite the fact that the trust finance function had actively communicated PLICSs as a new costing tool and often required its use in, for example, business cases for clinical investment. Operational financial management at the trusts was undertaken through service line reporting (SLR) and traditional directorate budgets. PLICSs were considered more of a strategic tool.ConclusionsBoth PLICSs and SLR identify and interrogate service line profitability. Although trusts currently cross-subsidise to support loss-making areas under the tariff, they are actively considering disinvesting in unprofitable service lines. Financial pressure within the NHS, along with its current competitive, business-oriented ethos, induces trusts to act in their own interests rather than those of the whole health economy. However, many policy commentators suggest that care integration is needed to improve patient care and reduce costs. Although the Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. London: The Stationery Office; 2012) requires both competition and the collaboration needed to achieve care integration, the two are not always compatible. We conclude that competitive forces are dominant in driving the current uses of PLICSs. Future research should interrogate the use of PLICSs inNew Care Models – Vanguard Sites(NHS England.New Care Models – Vanguard Sites. NHS England; 2015) and initiatives to deliver the ‘Five Year Forward View’ (Monitor and NHS England.Reforming the Payment System for NHS Services: Supporting the Five Year Forward View. London: Monitor; 2015).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Health Care Accommodation in Scotland

1982 ◽  
Vol 27 (4) ◽  
pp. 325-330
Author(s):  
James Maclachlan
Keyword(s):  
Health Care ◽  
Social Work ◽  
National Health Service ◽  
Health Service ◽  
Social Care ◽  
Community Services ◽  
Tabular Form ◽  
Hospital Beds ◽  
The Common ◽  
The Cost

The Medical and Nursing Advisers of the Scottish Health Service, Common Services Agency, Building Division, advise upon the planning of health care accommodation. The overall spread of beds by function is given in a review of existing health care buildings in the year 1981. The numbers of hospital beds and of various groups of staff in the hospital and community services are calculated per 100,000 population so that any unusual disparity can be ascertained. One of the parameters for health building planning is fiscal control and so the cost per hospital in-patient week is tabulated for eight groups of specialities. The appropriate responsibilities of the Regional Councils in Scotland in 1979 are considered along with the responsibilities of Health Boards because part of each Social Work Department's work is the provision of accommodation and social care for those in need as opposed to the National Health Service responsibility for the health care of those in hospital and in the community. An overall view of residential accommodation for those requiring medical treatment or social care is presented in tabular form. The views expressed are not necessarily those of the Common Services Agency.

scholarly journals The cost associated with disease-related malnutrition in Ireland

2012 ◽  
Vol 15 (10) ◽  
pp. 1966-1972 ◽  
Author(s):  
Niamh Rice ◽  
Charles Normand
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Large Scale ◽  
Social Care ◽  
Health Care Utilisation ◽  
Increased Risk ◽  
Health And Social Care ◽  
The Republic ◽  
The Uk ◽  
The Cost

AbstractObjectiveThe present study aimed to establish the annual public expenditure arising from the health and social care of patients with diet-related malnutrition (DRM) in the Republic of Ireland.DesignCosts were calculated by (i) estimating the prevalence of DRM in health-care settings derived from age-standardised comparisons between available Irish data and large-scale UK surveys and (ii) applying relevant costs from official sources to estimates of health-care utilisation by adults with DRM. No attempt has been made to estimate separately the costs of DRM and any associated disease, since each can be a cause or consequence of the other. The methods used are adapted from an evaluation of the cost of malnutrition in the UK by the British Association for Parenteral and Enteral Nutrition (2009).SettingsHospitals, nursing homes, out-patient clinics, primary-care clinics and home care.SubjectsAll adult patients receiving hospital in-patient, out-patient or specified community health-care services.ResultsThe annual public health and social care cost associated with adult malnourished patients in Ireland is estimated at over €1·4 billion, representing 10 % of the health-care budget. Most of this cost arises in acute hospital or residential care settings (i.e. 70 %), with nutritional support estimated to account for <3 % of spend.ConclusionsThe cost associated with the care of patients with DRM is substantial and may rise as the proportion of older people within the population increases, a group at increased risk of DRM. Despite growing pressure on health-care budgets, little attention has been focused on the economic burden associated with DRM in Ireland or the potential for savings arising from improved detection and treatment of those at risk.

scholarly journals Einkarekstur eða ríkisrekstur í heilsugæslu: Samanburður á kostnaði og ánægju með þjónustu

2018 ◽  
Vol 14 (2) ◽  
pp. 69-84
Author(s):  
Héðinn Sigurðsson ◽  
Sunna Gestsdóttir ◽  
Sigríður Halldórsdóttir ◽  
Kristjan G. Guðmundsson
Keyword(s):  
Health Care ◽  
Consumer Satisfaction ◽  
Low Cost ◽  
Safety Net ◽  
Community Services ◽  
Quality Of Services ◽  
Private Health Care ◽  
The Cost ◽  
Health Care Centers

The organization of health care is one of the most complex present day challenges. Like other countries that run socialized health care systems, Icelanders face the question of the role of private enterprise in health care. The objective of this study was two-fold: to compare the cost of 17 private and state-run health care centers in the metropolitan area, and to compare consumer satisfaction related to these. At the beginning of Icelandic settlement, there were statutory laws decreeing that community services should be provided for those in need. By the Health Care Act in 1973, the Icelandic health care system fell under the Nordic welfare society with equal access and a tight safety net. The results show that the private health care centers had a low cost per work unit, but not the lowest. Four to seven state run health care centers had less expenditure per patient than the private centers. The cost of each doctor’s position was highest in one of the private clinics. Patient satisfaction surveys showed that there is no difference in the quality of services between these two different operating modes. A conclusion can be drawn from this study that it is not clear whether private health care improves the use of public funds or increases the quality of services.

scholarly journals Workshop: MigHealthCare - strengthening Community Based Care to minimize health inequalities

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Health Care ◽  
Health Inequalities ◽  
Health Care Access ◽  
Community Based ◽  
Improve Health Care ◽  
Care Access ◽  
Health And Social Care ◽  
Care Models ◽  
Improve Health ◽  
The Eu

Abstract Over the past few years, a large number of refugees, migrants and asylum seekers have reached the south-eastern points of entry of the EU, challenging health and social systems of bordering countries with a spillover effect to the rest of the EU. Refugees, asylum seekers and migrants are at higher risk of poverty and social exclusion compared to the local populations, while the different vulnerable groups face diverse barriers when accessing health services. In many cases they do not receive appropriate health and social care that best meets their needs. Furthermore, in the EU MS, different practices apply to health and social care delivery for migrants/refugees. Research has shown the importance of community-based models to improve health care access of vulnerable migrants and refugees. Such models include elements of good communication, cultural awareness, sensitivity and respect for the diverse cultural and ethnic backgrounds by community health care staff as well health education and primary healthcare services. Mig-HealthCare - strengthening Community Based Care to minimize health inequalities and improve the integration of vulnerable migrants and refugees into local communities, is a 3-year project, launched in 2017, with the financial support of the European Commission. It is implemented by a consortium of 14 partners among them universities, national authorities and NGOs from ten countries across Europe (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). The overall objective of Mig-HealthCare is to improve health care access for vulnerable migrants and refugees, support their inclusion and participation in European communities and reduce health inequalities. The project’s specific objectives are: Describe the current physical and mental health profile of vulnerable migrants and refugees including needs, expectations and capacities of service providers.Develop a roadmap and toolbox for the implementation of community based care models, following an assessment of existing health services and best practices.Train community service providers on appropriate delivery of health care models for vulnerable migrants and refugees.Pilot test and evaluate community based care models which emphasize prevention, physical and mental health promotion and integration. The project results are presented on behalf of the Mig-HealthCare consortium. Key messages The overall objective of Mig-HealthCare is to improve health care access for vulnerable migrants and refugees. The Mig-HealthCare project focuses on developing a roadmap to facilitate the effective implementation of community care models.

The Cost of Health Care — Highlights from a Discussion about Economics and Reform

2009 ◽  
Vol 361 (15) ◽  
pp. 1421-1423 ◽  
Author(s):  
Atul A. Gawande ◽  
Elliott S. Fisher ◽  
Jonathan Gruber ◽  
Meredith B. Rosenthal
Keyword(s):  
Health Care ◽  
Cost Of Health Care ◽  
The Cost

Autism Spectrum Disorder: Essentials for a Dental Expert

2020 ◽  
Author(s):  
Reddy V
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Clinical History ◽  
Oral Health Care ◽  
Autism Spectrum ◽  
Patient Support ◽  
Specialized Knowledge ◽  
Support Strategies ◽  
Important Concern ◽  
The Cost

Unique is a method that could help diagnosing a psychiatry condition, such as autism, by properly completing a patient's clinical history, with a comprehensive physical examination. It is important to diagnose individuals with autism spectrum, since providing a good oral health care to these people requires that the dentist has specialized knowledge, an increased awareness and care while performing the treatment, and even patient support strategies which must be adapted to each case. Every patient with autism is different to the rest, which makes their diagnosis and treatment difficult. Likewise, not all dentists are qualified to provide a good oral health care to patients diagnosed with autism spectrum, so many families must fight with that barrier every day. Finally, not every person with autism, or their families, are able to afford the cost of dental care with a qualified dentist, which is an important concern for them.

scholarly journals The role of collaborative, multistakeholder partnerships in reshaping the health management of patients with noncommunicable diseases during and after the COVID-19 pandemic

2021 ◽  
Author(s):  
Alessandro Monaco ◽  
Amaia Casteig Blanco ◽  
Mark Cobain ◽  
Elisio Costa ◽  
Nick Guldemond ◽  
...  
Keyword(s):  
Health Management ◽  
Digital Health ◽  
Patient Empowerment ◽  
Advisory Board ◽  
Noncommunicable Diseases ◽  
Informal Carer ◽  
Economic Support ◽  
Health And Social Care ◽  
Care Models ◽  
Multistakeholder Partnerships

Abstract Background Policies to combat the COVID-19 pandemic have disrupted the screening, diagnosis, treatment, and monitoring of noncommunicable (NCD) patients while affecting NCD prevention and risk factor control. Aims To discuss how the first wave of the COVID-19 pandemic affected the health management of NCD patients, identify which aspects should be carried forward into future NCD management, and propose collaborative efforts among public–private institutions to effectively shape NCD care models. Methods The NCD Partnership, a collaboration between Upjohn and the European Innovation Partnership on Active and Healthy Ageing, held a virtual Advisory Board in July 2020 with multiple stakeholders; healthcare professionals (HCPs), policymakers, researchers, patient and informal carer advocacy groups, patient empowerment organizations, and industry experts. Results The Advisory Board identified barriers to NCD care during the COVID-19 pandemic in four areas: lack of NCD management guidelines; disruption to integrated care and shift from hospital-based NCD care to more community and primary level care; infodemics and a lack of reliable health information for patients and HCPs on how to manage NCDs; lack of availability, training, standardization, and regulation of digital health tools. Conclusions Multistakeholder partnerships can promote swift changes to NCD prevention and patient care. Intra- and inter-communication between all stakeholders should be facilitated involving all players in the development of clinical guidelines and digital health tools, health and social care restructuring, and patient support in the short-, medium- and long-term future. A comprehensive response to NCDs should be delivered to improve patient outcomes by providing strategic, scientific, and economic support.

scholarly journals Community-based intervention to prevent the incidence of Non-Communicable Diseases in the migrant population: Pilot study in Valencia (Spain)

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Gil-Salmerón
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Health Education ◽  
Host Country ◽  
Health Care Access ◽  
Communicable Diseases ◽  
Community Services ◽  
Migrant Population ◽  
Non Communicable Diseases ◽  
Life Years

Abstract Non-Communicable Diseases (NCDs) are prevalent in the migrant population with increased years of residency in the host country. In this regard, health education and lifestyle interventions have proven to be cost-effective modifying risk factors. The Spanish pilot of the Mig-HealthCare project directly aims to reduce the prevalence of NCDs reducing the well-known “healthy migrant effect” by increasing the levels of health literacy and also turning the lifestyles of the participants into healthier habits in the host country. The Mig-HealthCare pilot in Spain is a one-month group-based Health Education and Lifestyle Intervention to prevent the incidence of non-communicable diseases in Migrant and refugee populations addressing their Acculturation Process (HELP-MAP). Consequently, the pilot intervention addressing 4 topics: health literacy, physical activity, dietary patterns and strategies for coping with stress. The implementation of the pilot will be carried out in two different community services (i) one NGO providing care and accommodation for asylum seekers and (ii) three social care units within primary health care centres. Furthermore, following the Mig-Healthcare study protocol evaluation will focus on acculturation strategies, level of health literacy, physical exercise, change in diet, use of health care access and Quality-Adjusted life-years (QALY)

scholarly journals A narrative review of literature on the use of health and social care by older trans adults: what can United Kingdom services learn?

2021 ◽  
pp. 1-22
Author(s):  
Susan Mary Benbow ◽  
Charlotte Eost-Telling ◽  
Paul Kingston
Keyword(s):  
Health Care ◽  
Social Care ◽  
The United States ◽  
Narrative Review ◽  
Cultural Humility ◽  
Service Improvement ◽  
Service Users ◽  
Strong Argument ◽  
Health And Social Care ◽  
Economic Inequalities

Abstract We carried out a narrative review and thematic analysis of literature on the physical health care, mental health care and social care of trans older adults to ascertain what is known about older trans adults’ contacts with and use of health and social care. Thirty papers were found: a majority originated in the United States of America. Five themes were identified: experience of discrimination/prejudice and disrespect; health inequalities; socio-economic inequalities; positive practice; and staff training and education. The first three themes present challenges for providers and service users. Experiences of discrimination/prejudice and disrespect over the course of their lives powerfully influence how older trans adults engage with care services and practitioners. Health and socio-economic inequalities suggest that older trans adults are likely to have greater need of services and care. The remaining two themes offer opportunities for service improvement. We conclude that more research is needed, that there is a strong argument for taking a lifecourse perspective in a spirit of cultural humility, and that contextual societal factors influence service users and providers. We identify positive trans-inclusive practices which we commend to services. More needs to be done now to make older adult services appropriate and welcoming for trans service users.

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