health economic tools for jsna

7/28/2019 Health Economic Tools for JSNA

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Health Economics Tools for

JSNA

Susan Hamilton

Sandra Shcherba


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Overview

Why Health Economics?

What is Health Economics?

Programme Budgeting What it is

Data and tools

Marginal Analysis

NICE costing tools new developments


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Why health economics?

Major refresh of the local JSNA in 2011

25 chapters in 5 sections

Health & wellbeing, Children & young people

Safer & stronger

Transport, economy & environment

Overview of health


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Structure Why is this important What are the needs of the population

Current service provision

Community Voice What works

Challenges for consideration

Aprox. 30 authors from PCT and LA Limited guidance given on content


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What went into the JSNA Overview of health Contained health profile information

Included results from SPOT tool

Provides overview of spend & outcomes

Details of disease areas with highest spend &outliers

Some references to but no consistentapproach


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Questions of Authors questions Making the economic case for prevention (national

documents / NICE costing templates)

Cost-effectiveness / benefits of current service Evaluating health impact of disinvestment

Commissioner questions

What do I put in the acute trust contract?

How do I make a case for investment in

prevention?


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National GuidanceLocal Government Improvement and Development. JSNAa springboard for action

Nevertheless, the potential for JSNA to be at the centre ofcommissioning decisions has not yet been fully realised.

Considerable scope still exists to ensure JSNA informs

investment and decommissioning decisions as well as

guiding efficiencies in service provision.


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Going forward Programme Budgeting Including in the new JSNA chapter on mental health

Guidance

More detailed guidance developed for authors

Population needs inc.impact on health and/orsocial care or wider societal costs

Current service provision inc. cost benefit

Local H&W board consider issues of costeffectiveness in relation to PH outcomes.


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Challenges Link with annual commissioning cycle. Political dimension of including

PCT skills limited in health economics. Technical difficulties of undertaking proper

economic assessment.

Where to focus first breadth vs depth?

What timescales?


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What is health economics? Looks at the economic aspects of health and

healthcare

Uses methods such as epidemiology and

economic theories to assess and managehealthcare resources and their impact.

EconomicsMedicine

Health

economics


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Programme Budgeting- What is it?

Programme budgeting is an appraisal of

past resource allocation () in specified

programmes of care, rather than services,with a view to tracking future resource

allocation in those same programmes.


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Programme Budgeting- What is it for?

The aim is to maximise health gain by

deploying the available resources to best

effect.


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Programme Budgeting

Can help commissioners to assess

how they spend their allocation over 23 disease

categories and their respective subcategories; how their disease category level expenditure is

split across 12 care settings (2010-11 only) and;

how their expenditure distribution pattern

compares with other commissioners nationally,locally or with similar characteristics


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23 Programme Budgeting Categories

1 Infectious Diseases

2 Cancers & Tumours

3 Blood Disorders

4 Endocrine, Nutritional and Metabolic

Problems

5 Mental Health Problems6 Learning Disability Problems

7 Neurological System Problems

8 Eye/Vision Problems

9 Hearing Problems

10 Circulation Problems (CVD)

11 Respiratory System Problems

12 Dental Problems

13 Gastro Intestinal System Problems

14 Skin Problems

15 Musculoskeletal System Problems(excludes Trauma)

16 Trauma & Injuries

17 Genito Urinary System Disorders(except infertility)

18 Maternity & Reproductive Health

19 Neonates

20 Poisoning

21 Healthy Individuals

22 Social Care Needs23 Other Conditions


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Programme Budgeting- What is it?

All PCTs in England have submitted an annualprogramme budgeting return since 2003/4.

Data is published on Department of Health Website

(http://www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/Programmebudgeting/)


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Programme Budgeting Outputs- Tools

Help to view and analyse PB data, mainly by linkingexpenditure information with health outcomes

Key tools are:

1. Benchmarking tool

2. Programme Budgeting Atlas

3. NHS Comparators

4. Inpatient Variation Expenditure Tool (IVET)

5. Spent and Outcomes Tool (SPOT)6. Patient Reported Outcome Measures Tool (PROMT)

Health

Investment

Pack (HIP)


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Health Investment Packs (HIP)

Available at:

http://www.ic.nhs.uk/services/in-development/right-care/health-investment-

packs/south-west


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1. Benchmarking tool

Commissioner level expenditure data

National expenditure Cancer Network level

Cardiovascular disease network level


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Benchmarking tool

Commissioner level expenditure


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2. Programme Budgeting Atlas

Produces maps of expenditure and

outcomes

includes health outcomes, QualityOutcome Framework (QOF) data and

Hospital Episodes Statistics (HES) data


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3. NHS Comparators provides quarterly inpatient activity and expenditure data by

programme budget at England, SHA, Commissioner and Practicelevel.

includes:

total admissions activity and expenditure

non-elective admissions activity and expenditure elective admissions activity and expenditure

prescribing items and expenditure

better care better value metrics including low cost statin prescribing

nww.nhscomparators.nhs.uk

[NHSNet users only]


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Inpatient Variation Expenditure Tool

(IVET)

calculates potential savings by reducing

admissions across major disease groups

and for interventions with the highestspend.


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Inpatient Variation Expenditure Tool

(IVET)

The tool provides PCTs with:

inpatient expenditure data (2008/9) on different diseases

and interventions; Inpatient expenditure per 1000 population, standardising forage, sex and need (deprivation);

Comparative data to other PCTs

Allows PCTs to select a high cost disease or procedure,choose a benchmark level (eg median, lowest 10%) andview potential savings.


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Inpatient Variation Expenditure Tool (IVET)


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5. Spend and Outcome Tool (SPOT)

Graphic tool to identify areas for potential investment or

disinvestment or service improvement

Consists of factsheets and tool

The tool contains more details allows different outcomemeasures for some programmes, which can be

displayed on the quadrant chart

Available from the YHPHO website

http://www.yhpho.org.uk/spot


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Higher Spend,

Worse Outcome

Lower Spend,

Worse Outcome


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Higher Spend,

Worse Outcome

Lower Spend,

Worse Outcome


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6. Patient Reported Outcome Measures

Tool (PROMT)

assists health investment decisions by

comparing expenditure and patient reported

outcomes at local level for: hip and knee replacements

groin hernia

varicose veins


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PROMPTKnee replacement


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IVET and PROMPT are both available on

the NHS Networks website:

http://www.networks.nhs.uk/nhs-networks/health-investment-network


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PBMA

Stands for Programme Budgeting and MarginalAnalysis

Often only Programme Budgeting data used

Marginal analysis explicitly assesses the costsand benefits of proposed changes in the deliveryof health care

For investment as well as disinvestment


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PBMA PB answers question on what and where money

is currently spent

MA identifies areas for growth (wish list) andareas for resource release (hit list)

Hit List

What services can be

provided with less

resources?

What services can bestopped or scaled

back?

Wish List

What services should

receive more resources

to better meet the need

of the population?


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Very good worked examples and video

presentations on PBMA are available on the

Health Knowledge (Public Health) website:

http://www.healthknowledge.org.uk/interactive-learning/pbma


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Limitations

Coding issues

Local definitions

programme budgeting input data bit of amystery for non-finance people

Category 23 problem (Other Conditions)


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NICE COSTING TOOLS


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Types of NICE costing tools

All NICE guidance (except interventional procedures) published sinceJanuary 2005 has costing tools.

Types of NICE costing tools National cost reports -national estimated cost and implementing the

guidance. Business case

presents the financial costs and benefits of implementing guidance.

Costing statements are used when cost impact is considered to be minimalto explain why the cost impact is not considered to be significant.

Cost impact and commissioning assessment for NICE quality standards.


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Local impact of NICE guidance

Costing templates estimate the local cost of implementing

guidance and public health guidelines.

assess the impact guidance will have onlocal budgets


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Cost Summary


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Beware of assumptions


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New NICE public health tools

Shift from cost impact and cost utilitymeasures (QUALY) to Return on

Investment methodology

First project is for tobacco control, thenareas such as obesity

Looks at scenarios around different

interventions where national cost-effectiveness data may be ignored


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New NICE public health tools

Current methods Future approach

Live time benefits Short (1-2yrs), medium

(5yrs), longterm

outcomes

Health outcomes Health and non-health(eg social care) outcomes

NHS view (generally) Costs and benefits for

wider society (economy,

social care, employment)

Takes national evidencefor efficacy and cost-

benefit

Will allow changes andomission of cost-benefit

data

health economic tools for jsna

Documents