The effects of stochastic demand and expense preference behaviour on public hospital costs and excess capacity

Objetivo: descrever as internações, óbitos e custos públicos hospitalares por Diabetes Mellitus no Nordeste brasileiro entre 2013 e 2017. Método: trata-se de estudo quantitativo, descritivo e ecológico com levantamento de dados secundários do Sistema de Informações Hospitalares. Coletaram-se os dados referentes às internações, óbitos, custos hospitalares, valor médio de internação e média de permanência. Analisaram-se os dados mediante estatística descritiva simples, apresentando-os por meio de tabelas elaboradas no software Excel. Resultados: registraram-se 136.504 internações e 7.424 óbitos por Diabetes Mellitus no Nordeste brasileiro. Destacaram-se, além disso, os custos públicos hospitalares superiores a R$ 65 milhões, com valor médio de internação de R$ 545,08 e média de permanência de 5,4 dias. Conclusão: conclui-se que as internações, óbitos e os custos públicos hospitalares por Diabetes Mellitus apresentaram discreta redução e, mesmo assim, implicaram, de maneira expressiva, o orçamento público, além das repercussões pessoais e familiares impostas pela doença. Descritores: Saúde Pública; Epidemiologia; Endocrinologia; Custos de Cuidados de Saúde; Doenças do Sistema Endócrino; Indicadores Básicos de Saúde.Abstract Objective: to describe hospitalizations, deaths and public hospital costs for Diabetes Mellitus in Northeastern Brazil between 2013 and 2017. Method: this is a quantitative, descriptive and ecological study with secondary data collection from the Hospital Information System. Data was collected regarding hospitalizations, deaths, hospital costs, average hospitalization value and average length of stay. Data was analyzed using simple descriptive statistics, presenting them using tables prepared using Excel software. Results: 136,504 hospitalizations and 7,424 deaths from diabetes mellitus were recorded in the Brazilian Northeast. Also noteworthy were the public hospital costs over R$ 65 million, with an average hospitalization value of R$ 545.08 and an average length of stay of 5.4 days. Conclusion: it can be concluded that hospitalizations, deaths and public hospital costs for Diabetes Mellitus showed a slight reduction and, even so, they significantly implied the public budget, in addition to the personal and family repercussions imposed by the disease. Descriptors: Public Health; Epidemiology; Endocrinology; Health Care Costs;ResumenObjetivo: describir las hospitalizaciones, muertes y costos hospitalarios por diabetes mellitus en el noreste de Brasil, entre 2013 y 2017. Método: se trata de un estudio cuantitativo, descriptivo y ecológico, con la recopilación de datos secundarios del Sistema de Informaciones Hospitalarias. Se recopilaron los datos de hospitalizaciones, muertes, costos hospitalarios, valor promedio y tiempo de permanencia de la hospitalización. Los datos se analizaron mediante estadísticas descriptivas simples y se presentaron a través de tablas elaboradas en el software Excel. Resultados: se registraron 136,504 hospitalizaciones y 7,424 muertes por diabetes mellitus en el noreste de Brasil. Además, se destacaron los costos hospitalarios públicos superiores a R $ 65 millones, con un valor promedio de hospitalización de R$ 545.08 y una permanencia con promedio de 5,4 días. Conclusión: se concluye que las hospitalizaciones, las muertes y los costos hospitalarios debidos a la diabetes mellitus presentaron una ligera reducción, y aun así, estaban significativamente implicados en el presupuesto público, además de las repercusiones personales y familiares impuestas por la enfermedad. Descriptores: Salud Pública; Epidemiología; Endocrinología; Costos de la Atención en Salud; Enfermedades del Sistema Endocrino; Indicadores de Salud.

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Relative contribution of overweight and obesity to rising public hospital in-patient expenditure in South Australia

Australian Health Review ◽

10.1071/ah17147 ◽

2019 ◽

Vol 43 (2) ◽

pp. 148 ◽

Cited By ~ 1

Author(s):

Allison Larg ◽

John R. Moss ◽

Nicola Spurrier

Keyword(s):

Population Health ◽

Obesity Prevention ◽

Public Hospital ◽

Financial Burden ◽

Hospital Costs ◽

South Australia ◽

Overweight And Obesity ◽

Public Healthcare ◽

Relative Contribution ◽

Expenditure Growth

Objective Arguments to fund obesity prevention have often focused on the growing hospital costs of associated diseases. However, the relative contribution of overweight and obesity to public hospital expenditure growth is not well understood. This paper examines the effect of overweight and obesity on acute public hospital in-patient expenditure in South Australia over time compared with other expenditure drivers. Methods Annual inflation-adjusted acute public admitted expenditure attributable to a high body mass index was estimated for 2007–08 and 2011–12 and compared with other expenditure drivers. Results Expenditure attributable to overweight and obesity increased by A$45million, from 4.7% to 5.4% of total acute public in-patient expenditure. This increase accounted for 7.8% of the A$583million total expenditure growth, whereas the largest component of total growth (62.4%) was a real increase in the average cost per separation. Conclusions The relatively minor contribution of overweight and obesity to expenditure growth over the time period examined invites reflection on arguments to boost preventive spending that centre upon reducing hospital costs. These arguments may inadvertently detract attention from the considerable health and social burdens of overweight and obesity and from unrelated sources of expenditure growth that reduce opportunities for state governments to fund obesity prevention programs despite their comparative benefits to population health. What is known about the topic? Stand-alone estimates suggest that overweight and obesity are placing a considerable financial burden on the Australian public healthcare system. What does this paper add? Our findings challenge common perceptions about the relative importance of overweight and obesity in the context of rising public in-patient expenditure in Australia. What are the implications for practitioners? Consistent serial estimates of overweight- and obesity-attributable expenditure enable its tracking and comparison with other potentially controllable expenditure drivers that may also warrant attention. Explicit consideration of population health trade-offs in expenditure-related decisions, including in enterprise bargaining, would enhance transparency in priority setting.

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Sociodemographic variations in the amount, duration and cost of potentially preventable hospitalisation for chronic conditions among Aboriginal and non-Aboriginal Australians: a period prevalence study of linked public hospital data

BMJ Open ◽

10.1136/bmjopen-2017-017331 ◽

2017 ◽

Vol 7 (10) ◽

pp. e017331 ◽

Cited By ~ 5

Author(s):

David Banham ◽

Tenglong Chen ◽

Jonathan Karnon ◽

Alex Brown ◽

John Lynch

Keyword(s):

Chronic Conditions ◽

Public Hospital ◽

Aboriginal People ◽

Hospital Costs ◽

Prevalence Study ◽

Hospital Data ◽

Aboriginal Australians ◽

Period Prevalence ◽

Preventable Hospitalisation ◽

Population Average

ObjectivesTo determine disparities in rates, length of stay (LOS) and hospital costs of potentially preventable hospitalisations (PPH) for selected chronic conditions among Aboriginal and non-Aboriginal South Australians (SA), then examine associations with area-level socioeconomic disadvantage and remoteness.SettingPeriod prevalence study using linked, administrative public hospital records.ParticipantsParticipants included all SA residents in 2005–2006 to 2010–2011. Analysis focused on those individuals experiencing chronic PPH as defined by the Australian Institute of Health and Welfare.Primary outcome measuresNumber and rates (unadjusted, then adjusted for sex and age) of chronic PPH, total LOS and direct hospital costs by Aboriginality.ResultsAboriginal SAs experienced higher risk of index chronic PPH compared with non-Aboriginals (11.5 and 6.2 per 1000 persons per year, respectively) and at younger ages (median age 48 vs 70 years). Once hospitalised, Aboriginal people experienced more chronic PPH events, longer total LOS with higher costs than non-Aboriginal people (2.6 vs 1.9 PPH per person; 11.7 vs 9.0 days LOS; at $A17 928 vs $A11 515, respectively). Compared with population average LOS, the standardised rate ratio of LOS among Aboriginal people increased by 0.03 (95% CI 0.00 to 0.07) as disadvantage rank increased and 1.04 (95% CI 0.63 to 1.44) as remoteness increased. Non-Aboriginal LOS also increased as disadvantage increased but at a lower rate (0.01 (95% CI 0.01 to 0.01)). Costs of Aboriginal chronic PPH increased by 0.02 (95% CI 0.00 to 0.06) for each increase in disadvantage and 1.18 (95% CI 0.80 to 1.55) for increased remoteness. Non-Aboriginal costs also increased as disadvantage increased but at lower rates (0.01 (95% CI 0.01 to 0.01)).ConclusionAboriginal people’s heightened risk of chronic PPH resulted in more time in hospital and greater cost. Systematic disparities in chronic PPH by Aboriginality, area disadvantage and remoteness highlight the need for improved uptake of effective primary care. Routine, regional reporting will help monitor progress in meeting these population needs.

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Stochastic demand, production responses and hospital costs

Journal of Health Economics ◽

10.1016/s0167-6296(03)00048-1 ◽

2003 ◽

Vol 22 (6) ◽

pp. 999-1010 ◽

Cited By ~ 40

Author(s):

David Hughes ◽

Alistair McGuire

Keyword(s):

Hospital Costs ◽

Stochastic Demand

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