Healthcare in Focus 2013:How does NSW measure up?

Recommendation 76 

The functions of the Bureau are to include,but not be limited to …

• Provide an Annual Report on the Patient Care Performance criteria, together any other relevant performance criteria to the NSW Parliament on NSW Health

The Garling Report

Annual performance report

• A wide-ranging “whole of system” perspective on healthcare in NSW

• Puts NSW performance in an international context

• Assesses performance in terms of the response to the health needs of the people of NSW

• Strikes a balance between providing a comprehensive assessment and focusing on key performance measures

• Based on a new performance framework to guide assessment

• 135 indicators, multiple data sources

Productivity Commission

OECD

Australian Institute of Health and Welfare

Australian Bureau of Statistics

NSW Ministry of Health

Commonwealth FundClinical Registries

Data sources

Interpreting the report

Taking a patient-eye view …

• Includes information on the state government-funded hospital system and on primary care services which are largely a federal government policy and funding responsibility

• Contains some sets of figures that include both public and private sector healthcare

• Draws on information from 2013 or the most recent year for which data are available

• Presents performance indicators selected on the basis of international data availability. Therefore, the indicators do not completely align with current NSW performance priorities

Setting the scene

Resources & utilisation: expenditure and outputsOverview of outputs in the NSW healthcare system 2011-12

Source: Bureau of Health information.

Resources & utilisation: why were people hospitalised?Hospitalisations (public and private) by ICD-10 chapters (showing specific causes with more than 5,000 hospitalisations)

* NSW Ministry of Health, NSW Admitted Patient Data Collection, extracted from SAPHaRI. Centre for Epidemiology and Research. (BHI analysis) Data exclude newborns ‘without qualification days’ (ie. well newborns) Note: Hospitalisations refer to episodes of care. There can be multiple episodes of care in a single hospital stay. Chapters with fewer than 15,000 hospitalisations are not shown. Only principal diagnoses with > 5,000 hospitalisations are shown.Source: Bureau of Health information.

Frequently hospitalised peopleHospitalisation frequency and bed day use (public and private hospitals), 2012-13

Source: NSW Ministry of Health, extracted from SAPHaRI. Centre for Epidemiology and Research (BHI analysis)

Emergency department visitsFrequency of ED visits, NSW, 2011–12

Source: NSW Ministry of Health, extracted from SAPHaRI. Centre for Epidemiology and Research (BHI analysis)Note: visits are those ED with electronic data collection, which represent 88% of all ED visits.

Report Structure and Results

- using an integrated performance assessment framework

An integrated performance assessment framework

Out of pocket healthcare costs

Commonwealth Fund survey 2013 In the past 12 months, how much have you and your family spent out-of-

pocket for medical treatments or services that were not covered by insurance? 

The Commonwealth Fund, 2013 Commonwealth Fund International Health Policy survey. Estimate statistically significantly higher or lower than NSW as noted by the up and down arrows.

Accessibility and availability

Commonwealth Fund survey 2010 and 2013 The last time you went to the hospital emergency department, was it for a

condition that you thought could have been treated by the doctors or staff at the place where you usually get medical attention?

The Commonwealth Fund, 2013 Commonwealth Fund International Health Policy survey. Estimate statistically significantly higher or lower than NSW as noted by the up and down arrows.

Appropriateness - Caesarean sections - international

Caesarean sections per 1,000 live births, 2000–2011

Source OECD, OECD Health Statistics 2013.NSW Ministry of Health, Adult Admitted Patient Collection, extracted from SAPHaRI, Centre for Epidemiology and Evidence NSW (BHI Analysis).

Appropriateness – Caesarean sections

Hospital variation in percentage of deliveries by caesarean section (public and private hospitals) NSW 2010–11

NSW Health, Mothers and Babies 2010. Note: Hospitals were also categorised according to whether they were above or below median rate of caesarean sections thatwere emergencies (43%).

Appropriateness – technically proficient

Commonwealth Fund survey 2013 In the past two years, have you experienced the following?

The Commonwealth Fund, 2013 Commonwealth Fund International Health Policy survey. Estimate statistically significantly higher or lower than NSW as noted by the up and down arrows.

Appropriateness – discharge processes

The Commonwealth Fund, 2013 Commonwealth Fund International Health Policy survey. Estimate statistically significantly higher or lower than NSW as noted by the up and down arrows.

Commonwealth Fund survey 2013 When you left the hospital did someone discuss with you the purpose of taking each of

your medications?

Effectiveness – system view

The Commonwealth Fund, 2013 Commonwealth Fund International Health Policy survey. Estimate statistically significantly higher or lower than NSW as noted by the up and down arrows.

Commonwealth Fund survey 2013 Which of the following statements comes closest to expressing your overall view of the

healthcare system in this country:

Effectiveness - PROMs

Effectiveness – complications of care

Hospitalisations (public and private) for complications of surgical or medical care (principal diagnosis), 2000–01 to 2011–12

Source: OECD, OECD Health Data 2013.Source: NSW Ministry of Health, extracted from SAPHaRI, Centre for Epidemiology and Evidence NSW (BHI analysis).

Effectiveness – types of complications

Number of hospitalisations (public and private) by type of complications of surgical or medical care, NSW, 2012–13

Source: NSW Ministry of Health, extracted from SAPHaRI, Centre for Epidemiology and Evidence NSW (BHI analysis).

Efficiency – Average length of stay in hospital

Figure 5.8 Average length of stay for heart attack, congestive heart failure and stroke 2011 (or most recent) (OECD 17 ALOS AMI HF CV) (source OECD and SAPHaRi)

Source: OECD, OECD Health Statistics 2013.Source: NSW Ministry of Health, extracted from SAPHaRI, Centre for Epidemiology and Evidence NSW. Overnight acute episodes only .

Average length of stay for heart attack, congestive heart failure and stroke (public and private hospitals), 2011 (or most recent)

Equity – Insurance associated gaps

Source: The Commonwealth Fund, 2013 Commonwealth Fund International Health Policy survey. Estimate of group without private insurance statistically significantly different than the group with private insurace as noted by shading.

Comparing responses between those with and without private medical insurance

How does NSW measure up?

From the patients’ point of view, this report shows how well the system achieves its objectives of providing care when and where it is needed; delivering the right healthcare, in the right way; and ensuring that healthcare makes a difference for patients.

NSW compares favourably in the international context