Empirical evaluation of home-based reablement: A review

Home-based reablement (HBR) aims to restore or increase patients’ level of functioning, thereby increasing the patients’ self-reliance and consequently decreasing their dependence on healthcare services. To date, the evidence on whether HBR is an efficient method has not been comprehensively reviewed. The aim of this study was to provide a concise summary of relevant existing findings. In addition, we provide a critical constructive assessment of the publications reflecting the extant research. The relevant literature on this topic was identified through a systematic search of appropriate databases. Thereafter, we screened the studies, first by title, followed by abstract and then by assessing full-text eligibility. A checklist of 15 criteria was developed and used as the basis for the quality assessment. In total, 12 studies from Australia, New Zealand, the USA and Norway were included in the full-text review. The studies reported estimated cost differences between HBR and usual care after the intervention. All the studies indicated lower costs for HBR, but not all of them reported a significant difference. The same pattern was also found for other measures of physical functioning and quality of life. The assessment revealed one specific common pattern: None of the papers scrutinized provided sufficient information about the data or the statistics employed, and all lacked external validity. Some promising results have been reported with respect to HBR reducing the need for specialist or residential care. In short, the existing evidence regarding the effects of HBR is still inconclusive. The findings from the quality assessment should motivate a multidisciplinary approach for future research on HBR. Published: Online May 2021.

Does the responsibility patients exert determine their opportunities for best clinical practice in the healthcare system?

Many consider inequality in health unfair if it is caused by inequality within the healthcare system but less unfair when caused by individuals’ health behaviour. However, healthcare systems are challenged when it comes to ensuring equal care for equal need. In Roemer’s equality of opportunity theory, people have equal opportunity for obtaining something if obtaining it reflects their effort instead of their circumstances. Very little is known about how responsibility exerted by patients prior to illness affects the healthcare they are provided by the healthcare system. We aimed to apply Roemer’s theory to an acute care setting where healthcare is most directly in the hands of the healthcare system in order to study the role of patient-exerted responsibility for their opportunities in the healthcare system. We operationalised the responsibility patients exert as Body Mass Index (BMI), smoking and alcohol habits, and their circumstances as demographics, socioeconomics, prognostic factors and year of discharge. Opportunity in healthcare was defined as patients’ attainment of clinical guideline-recommended acute hospital care. In Roemer’s theory, we detected inequality of opportunity as restricted attainment of healthcare was mainly associated with patients’ circumstances, such as lower education, old age or living alone. We also identified a strong association with BMI; being underweight negatively affected patients’ opportunities as it led to suboptimal healthcare, while the opposite was found for being overweight and, in particular, obese. Hence, patient-exerted responsibility affected patients’ opportunities in healthcare, though perhaps in an unexpected way. This improved understanding of inequality may help to focus future research and, in the long term, support clinical and political efforts to achieve equal care for equal needs. Published: Online March 2021.

Biosimilar bidding in centralized tenders in Norway

Our objective is to study the competition effect of biosimilar entry in centralized tenders for an expensive category or drugs - TNF-inhibitors. We use monthly observations of prices and volumes for all brands and biosimilars in this drug category in Norway, covering the period from Jan. 2006 to Dec. 2016. Descriptive statistics and regression models are used to investigate the impact of biosimilars on the drug price and the effect of the number of brands on the intensity of competition. Both the entry of biosimilars and new branded drugs have increased competition and reduced prices. According to our estimates, an increase in the market share of biosimilars from 10 % to 60 %, will be accompanied with a 50 % reduction in the expected price. Only two years after entry, the first biosimilars in this drug category had gained a market share of 40 % in Norwegian hospitals. Although entry barriers for biosimilars are higher than for generics of chemical substances, significant cost savings are expected from patent expirations of expensive biologics as well. The centralized design of the tenders is an important institutional factor behind the strong competition effect. Published: Online January 2020

Regional variation in public long-term home care : Regional differences in the Netherlands and the role of patient experiences

Practice variation is often defined as variation in access to healthcare - usually across regions - that cannot be explained by differences in patient populations. Practice variation may therefore lead to inefficiency and violate the principle of equal access to healthcare. The study of practice variation in long-term care (LTC) is a comparatively new area of research. This paper focuses on variation in publicly financed home care, which is gaining popularity as an alternative for institutional care. In addition, this paper focuses on whether and how patient experiences are associated with this variation. We use multinomial logistic regression analyses to assess regional variation in entitlements for publicly financed home care. Linear regression analyses were added to examine regional variation in intensity of entitled publicly financed home care, and the relationship between variation and patient experiences. The study showed a maximum difference of 34 percentage points across regions. Moreover, a maximum of 23 out of 31 regions showed significant differences in intensity of entitled care. Almost none of the observed variation can be explained by patient experiences. Our study showed evidence that eligibility for publicly financed home care depended partially on where a client lived. This study has been performed before the major decentralisation of the Dutch LTC system in January 2015. We expect regional variation to increase as a result of local demand, supply factors and the budgetary restrictions of the local stakeholders. This imposes challenges for countries as the Netherlands, which introduced a shift towards using more publicly financed home while striving towards equal access. Published: Online December 2020.

Cost-effectiveness of a multi-professional case management experiment in Finnish labor market services

The study undertook an economic evaluation of a multi-professional case man-agement intervention targeted at long-term unemployed Finns. The cost-effectiveness outcome of the intervention was analyzed in a matched case-control study framework involving a six-month follow-up. Effectiveness was measured by standardized quality of life indicators, and an indicator measuring personal capabilities. Individual level costs were derived from health and social services utilization data. Cost-effectiveness of the intervention was examined in relation to services as usual. The studied labor market intervention was associated with a positive change in the selected quality of life indicators; physical and psychological quality of life improved in the intervention group. Cost-effectiveness in physical quality of life was attained at a willingness to pay of EUR 500 – 700 per effectiveness unit, while cost-effectiveness in psychological quality of life required incremental costs exceeding EUR 1,600. The intervention had no discernible effect on personal capabilities. The study demonstrated that favorable improvements in quality of life could be attained by a rather ‘light’ and moderate-cost service concept. Such well-being improvements may enhance the preparedness for re-employment of individuals with a prolonged unemployment history. However, a longer follow-up of the labor market intervention would be needed to examine the long-term effects on quality of life and employment. Published: Online October 2020.

Health-related quality of life (HRQoL) in children and adolescent with post-traumatic stress symptom: A comparison of 16D and condition-specific instruments

The objective of this study was to compare Health-Related Quality of Life (HRQoL) as measured by the 16D instrument with four condition-specific instruments in children and adolescents with significant post-traumatic stress disease (PTSD), to assess the validity of the 16D instrument. In addition, we test for differences in health for the PTSD population compared to a representative sample of Finnish schoolchildren. The study included 156 children and adolescents with trauma-related symptoms in Norway. The condition-specific instruments included were; Child PTDS Symptom Scale (CPSS); Mood and Feelings Questionnaire (MFQ); Screen for Child Anxiety Related Emotional Disorders (SCARED), and; Strengths and Difficulties Questionnaire (SDQ). We found that the 16D HRQoL score was significantly correlated with all condition-specific instruments (CPSS, SCARED, MFQ, and SDQ), where SCARED had the highest correlation with the 16D (-0.659, p < 0.01). Several of the corresponding items (sleep, distress, discomfort and symptoms, mental functioning, and school and hobbies) of the condition-specific instruments were correlated above the threshold (convergent validity, ρ > 0.4). Children and adolescents with symptoms of post-traumatic stress experienced a significant health loss of 0.177 compared to a representative sample of Finnish 12 to 15-years-old schoolchildren with a Cohen’s d of 1.07, and the health difference was significant for all 16 dimensions. These findings support the use of the 16D to measure health outcomes in cost-utility analysis. More studies are needed to examine the responsiveness. Published: Online August 2020.

Health care and long-term care costs by age and proximity to death in a publicly funded universal system: A descriptive study of population data

Trends in population ageing parallel concerns with escalating health care expenditures. The purposes of this study are to (1) estimate the distribution of health care and long-term care costs to ascertain the relative importance of age vs. proximity to death as the main driver of costs; (2) explore the relative importance of user rates and costs per user as the primary driver of per capita costs of selected services for survivors and decedents, respectively; and (3) provide projections of future costs. We use data on service use for the entire Norwegian population from four national registers linked with the Cause of Death Registry to calculate costs per decedent in the last 365 days of life and the average one-year costs of people surviving at least two years. Future costs were calculated using projections on population and probability of death from Statistics Norway. We find that the substantial increase in costs at older ages among both decedents and survivors relates to higher long-term care costs. Health care costs peak in the late 50s among decedents and in the early 80s among survivors and then decrease with age. While costs in the last year of life for each decedent are 19 times the average costs of survivors, the decedent/survivor cost ratio decreases with age to less than double among those aged ³95 years. Expenditure projections indicate an increase in spending due to population ageing, especially in long-term care expenditures. For somatic hospital costs, proximity to death has a greater impact on costs than age; the age effect is more important for long-term care, implying that the “red herring” effect is larger for acute health care than for long-term care. Adjusting for costs during the last year of life reduces the projected increase in expenditures, but only to a limited extent.

Health care consumption for somatic patients following a brief outreach alcohol intervention

This study explores health and social care consumption in two groups of patients with risk of alcohol use disorder (AUD), following a brief outreach alcohol intervention in a general hospital setting in Denmark. The Relay intervention aims to decrease health care contacts and thus primarily, in the long run, to reduce health care costs and secondarily to reduce labour market consequences and social costs for patients with alcohol problems. The study took place in somatic hospital departments with high prevalence of alcohol related injuries and illnesses. Patients admitted to the hospital between October 2013 and June 2016 were screened using the Alcohol Use Identification Test (AUDIT) and everyone scoring 8 points and above were randomised to either intervention (Relay group) or control group (TAU group). The patients (n=561) were followed for 12 months after discharge from the hospital. Data was gathered on somatic and psychiatric hospital admissions, GP visits and other primary health care visits as well as the costs associated with the health care contacts. In addition, data on social costs and productivity was gathered. All data was gathered from the Danish registers using personal identification numbers. We modelled the association using generalised linear modelling and investigated the costs further by performing a quantile analysis. We found no statistically significant difference in health care costs, social costs or productivity between the two groups. A longer follow-up is needed to fully investigate effects of the Relay intervention on changes in patients’ health behaviour and subsequently on health care costs.