Cost of medical injury in New Zealand: A retrospective cohort study

2002 ◽  
Vol 7 (1_suppl) ◽  
pp. 29-34 ◽  
Author(s):  
Paul Brown ◽  
Colin Mcarthur ◽  
Lynette Newby ◽  
Roy Lay-Yee ◽  
Peter Davis ◽  
...  
Keyword(s):  
Health Care ◽  
New Zealand ◽  
Adverse Events ◽  
Hospital Admissions ◽  
Patient Characteristics ◽  
Public Hospitals ◽  
Health Care Resources ◽  
Medical Injury ◽  
Co Morbidity ◽  
The Cost

Objective To estimate the cost of treating medical injury associated with hospital admissions in New Zealand and the patient characteristics of costly adverse events. Methods As part of the New Zealand Quality in Healthcare Study (NZQHS), a retrospective examination of medical records in 13 public hospitals identified the occurrence of clinical procedures and hospital bed days attributable to adverse events. The prices charged to foreign patients were used to estimate the cost of the health care resources used. Results 850 adverse events were identified in the NZQHS which cost an average of $NZ 10 264 per patient. For New Zealand, adverse events are estimated to cost the medical system $NZ 870 million, of which $NZ 590 million went toward treating preventable adverse events. The results suggest that up to 30% of public hospital expenditure goes toward treating an adverse event. The results also suggest that older patients, neonates and those with moderately serious co-morbidity tended to have more costly adverse events. Conclusions Adverse events lead to a significant use of health care resources in New Zealand. These findings suggest that substantial resources could be saved by eliminating preventable adverse events.

Home Visitation Investment

PEDIATRICS ◽  
1992 ◽  
Vol 89 (1) ◽  
pp. 169-169
Author(s):  
NORMAN J. SISSMAN
Keyword(s):  
Health Care ◽  
Home Visits ◽  
Cost Benefit ◽  
Home Visitation ◽  
Benefit Ratio ◽  
Health Care Resources ◽  
Detailed Consideration ◽  
Cost Benefit Ratio ◽  
Women And Children ◽  
The Cost

To the Editor.— Two recent reviews in Pediatrics1,2 provide much interesting information on the effect of home visits on the health of women and children. However, I was disappointed not to find in either article more than token reference to the cost of the programs reviewed. In this day of increasingly scarce health care resources, we no longer have the luxury of evaluating programs such as these without detailed consideration of their cost-benefit ratio.

Effects of the Blair/Brown NHS Reforms on Socioeconomic Equity in Health Care

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 55-63 ◽  
Author(s):  
Richard Cookson ◽  
Mauro Laudicella ◽  
Paolo Li Donni ◽  
Mark Dusheiko
Keyword(s):  
Health Care ◽  
Hip Replacement ◽  
Large Scale ◽  
Hospital Admissions ◽  
Public Hospitals ◽  
Patient Choice ◽  
Socioeconomically Disadvantaged ◽  
Equity In Health ◽  
Socioeconomic Equity ◽  
Equity In Health Care

The central objectives of the ‘Blair/Brown’ reforms of the English NHS in the 2000s were to reduce hospital waiting times and improve the quality of care. However, critics raised concerns that the choice and competition elements of reform might undermine socioeconomic equity in health care. By contrast, the architects of reform predicted that accelerated growth in NHS spending combined with increased patient choice of hospital would enhance equity for poorer patients. This paper draws together and discusses the findings of three large-scale national studies designed to shed empirical light on this issue. Study one developed methods for monitoring change in neighbourhood level socioeconomic equity in the utilization of health care, and found no substantial change in equity between 2001-02 and 2008-09 for non-emergency hospital admissions, outpatient admissions (from 2004-05) and a basket of specific hospital procedures (hip replacement, senile cataract, gastroscopy and coronary revascularization). Study two found that increased competition between 2003-04 and 2008-09 had no substantial effect on socioeconomic equity in health care. Study three found that potential incentives for public hospitals to select against socioeconomically-disadvantaged hip replacement patients were small, compared with incentives to select against elderly and co-morbid patients. Taken together, these findings suggest that the Blair/Brown reforms had little effect on socioeconomic equity in health care. This may be because the ‘dose’ of competition was small and most hospital services continued to be provided by public hospitals which did not face strong incentives to select against socioeconomically-disadvantaged patients.

scholarly journals How to use interpreters in general practice: the development of a New Zealand toolkit

2012 ◽  
Vol 4 (1) ◽  
pp. 52 ◽  
Author(s):  
Ben Gray ◽  
Jo Hilder ◽  
Maria Stubbe
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
New Zealand ◽  
Limited English Proficiency ◽  
Ethical Behaviour ◽  
Patient Relations ◽  
Primary Care Practitioners ◽  
The Cost ◽  
Patient Resistance

BACKGROUND AND CONTEXT: New Zealand is becoming more ethnically diverse, with more limited English proficiency (LEP) people. Consequently there are more primary care consultations where patients have insufficient English to communicate adequately. Because effective communication is essential for good care, interpreters are needed in such cases. ASSESSMENT OF PROBLEM: The literature on the use of interpreters in health care includes the benefits of using both trained interpreters (accuracy, confidentiality, ethical behaviour) and untrained interpreters (continuity, trust, patient resistance to interpreter). There is little research on the actual pattern of use of interpreters. RESULTS: Our research documented a low use of trained interpreters, despite knowledge of the risks of untrained interpreters and a significant use of untrained interpreters where clinicians felt that the communication was acceptable. A review of currently available guidelines and toolkits showed that most insist on always using a trained interpreter, without addressing the cost or availability. None were suitable for direct use in New Zealand general practice. STRATEGIES FOR IMPROVEMENT: We produced a toolkit consisting of flowcharts, scenarios and information boxes to guide New Zealand practices through the structure, processes and outcomes of their practice to improve communication with LEP patients. This paper describes this toolkit and the links to the evidence, and argues that every consultation with LEP patients requires clinical judgement as to the type of interpreting needed. LESSONS: Primary care practitioners need understanding about when trained interpreters are required. KEYWORDS: Communication barriers; primary health care; New Zealand; quality of health care; professional–patient relations; cultural competency

scholarly journals Inappropriate hospital stays and association with lack of homecare services

2021 ◽  
Vol 27 (07) ◽  
pp. 656-664
Author(s):  
Elham Siavashi ◽  
Zahra Kavosi ◽  
Farid Zand ◽  
Mitra Amini ◽  
Najmeh Bordbar
Keyword(s):  
Health Care ◽  
Hospital Stay ◽  
Home Health Care ◽  
Improve Patient Care ◽  
Patient Characteristics ◽  
Daily Basis ◽  
Cross Sectional Study ◽  
Home Health ◽  
Public Hospitals ◽  
Cross Sectional

Background: Efforts to reduce inappropriate hospital stay, including alternatives such as homecare, are important to improve patient care and reduce health care costs. Aims: This study evaluated inappropriate hospital stay in Shiraz, Islamic Republic of Iran and the extent to which these stays were due to lack of homecare services and others factors needed for homecare. Methods: This cross-sectional study was conducted between January 2018 and September 2019 at two public hospitals in Shiraz. All adult patients hospitalized in these two hospitals in the study period were included, except patients in mental care wards. Appropriateness of patients’ hospital stay was assessed on a daily basis using the Iranian version of the Appropriateness Evaluation Protocol. The chi-squared test was used to assess association between need for homecare and patient characteristics. Results: Of 6458 hospitalization days assessed (for 1954 patients), 710 (11.0%) days were inappropriate. The greatest proportion of causes of inappropriate stay were physician-related (32.9%). Of the 710 inappropriate hospitalization days, 231 were due to lack of homecare services. Most patients who were inappropriately hospitalized because of lack of homecare services were insured through Salamat insurance (64.0%). A statistically significant relationship was found between the need for homecare services and the type of health insurance (P = 0.01). Of the patients admitted to hospital because of lack of homecare services, 36.8% had endocrine diseases, especially diabetes, and 21.8% needed oxygen services. Conclusion: Institutionalizing home health care in the Iranian health system could encourage more home health care referral and reduce inappropriate hospitalization, especially for diabetes.

Is High-Flux Dialysis Cost-Effective?

1993 ◽  
Vol 9 (1) ◽  
pp. 85-96 ◽  
Author(s):  
John C. Hornberger ◽  
Alan M. Garber ◽  
Michael E. Chernew
Keyword(s):  
Cost Effectiveness ◽  
Hospital Admissions ◽  
Unit Cost ◽  
Cost Effective ◽  
Patient Characteristics ◽  
Maintenance Hemodialysis ◽  
Dialysis Session ◽  
High Flux ◽  
Endstage Renal Disease ◽  
The Cost

AbstractHigh-flux dialysis is a new method for providing routine-maintenance hemodialysis to patients with endstage renal disease. It promises to shorten the duration of the dialysis session, but poses potential clinical risks to patients and financial risks to dialysis centers because of the high unit cost of purchasing new dialysis equipment. We retrospectively evaluated the cost-effectiveness of high-flux dialysis compared to conventional dialysis in a hospital-based center. The center provided only conventional dialysis until March 1989, when it initiated high-flux dialysis. The estimated annual costs of treatment were US $31,249 (high-flux) and $32,562 (conventional). The rate of hospital admissions was almost identical in both groups (conventional, 1.29 admissions per year; high-flux, 1.24 admissions per year; p = 0.23). Predicted prolongation of life expectancy with high-flux dialysis was significantly higher after statistical adjustment for observable patient characteristics (1.8 to 4.5 years; p <0.01). The cost-effectiveness ratio was $28,188 per life-year saved for high-flux compared to conventional dialysis. These findings suggest that the added capital expense of purchasing high-flux equipment can be justified from the perspective of its societal cost-effectiveness.

Direct health care costs of hospital admissions due to adverse events in the Netherlands

2014 ◽  
Vol 24 (6) ◽  
pp. 1028-1033 ◽  
Author(s):  
Fabienne J. H. Magdelijns ◽  
Patricia M. Stassen ◽  
Coen D. A. Stehouwer ◽  
Evelien Pijpers
Keyword(s):  
Health Care ◽  
The Netherlands ◽  
Adverse Events ◽  
Health Care Costs ◽  
Hospital Admissions ◽  
Care Costs

Reform and counter reform: How sustainable is New Zealand&s latest health system restructuring?

2002 ◽  
Vol 7 (1_suppl) ◽  
pp. 46-55 ◽  
Author(s):  
Jackie Cumming ◽  
Nicholas Mays
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New Zealand ◽  
Health Services ◽  
Community Health Services ◽  
Public Hospitals ◽  
District Health ◽  
Potential Conflict ◽  
Feasible Option ◽  
New System

New Zealand's health care sector has undergone almost continual restructuring since the early 1980s. In the latest set of reforms, 21 district health boards (DHBs) have been established with responsibility for promoting health, purchasing services for their populations and delivering publicly owned health services. Boards will be governed by a mix of elected and appointed members, will be responsible for arranging the delivery of primary and community health services, and will own and run public hospitals and related facilities. We clarify the differences and continuities between earlier reforms and the 2000/01 structures, as well as the current reforms’ potential strengths and weaknesses. The paper discusses whether the DHB model was the only feasible option for restructuring and whether the dynamics of the new system may lead to further changes, particularly on the purchaser side of the system. Given that DHBs face potential conflict between their purchasing and provision roles, and given the potential advantages that primary care organisations may have as purchasers, we conclude that it is possible that all or part of the purchasing function of DHBs might eventually shift to primary care organisations, leaving the DHBs as hospital-based provider organisations.

scholarly journals Management of skin infections in Pacific children prior to hospitalisation

2013 ◽  
Vol 5 (1) ◽  
pp. 43 ◽  
Author(s):  
Elaine Ete-Rasch ◽  
Katherine Nelson
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Medical Attention ◽  
Skin Infections ◽  
Structured Interviews ◽  
Early Management ◽  
Primary Health

INTRODUCTION: Hospital admissions for childhood skin infections in New Zealand (NZ) are on the increase. Pacific children make up a high number of those who are admitted. This study describes the parents of Pacific children’s understanding and management of skin sores in the home prior to the sores becoming infected and requiring hospital admission. METHODS: A descriptive qualitative approach combined with the Pacific research frameworks of Fa’afaletui and the Metaphor of Kakala were used to elicit parents’ understanding and management of children’s skin sores in the home. The semi-structured interviews were conducted in English or Samoan, and all transcribed into English. FINDINGS: Mothers of 11 Pacific children admitted with skin infections between 2006 and 2008 were interviewed. The children’s infections started with insect bites in some cases. Parents actively sought treatment to ensure children’s optimal health was maintained. Initial management included a ‘watch and see’ approach for some, until deterioration was noted. CONCLUSION: This is the first known study in New Zealand that has captured children’s experiences when sustaining a skin infection/s and the activities that took place while seeking treatment in the community. Although most of the children received medical attention in primary health care (PHC), this did not prevent the need for hospital admission. The acuteness and seriousness of children’s health on admission shows that preventive efforts need to increase and the early management of infections in PHC settings needs to be better understood. KEYWORDS: Children; Pacific health, primary health care; skin infections

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