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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
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