Casecosting and audit in Swedish Health Care

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Case-costing and audit in Swedish Health Care

• Meeting In Island 16/9 - 2002
• Mona Heurgren, Senior economist
• Federation of Swedish County Councils, Sweden

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Agenda

• The Case-costing system
• The use of Case-costing from different
  perspectives in health care

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Case-costing in Sweden

• A National Case-costing project is finished this
  summer (1999-2002).
• 50 of the County Councils have local projects
  (70-80 of all cases)
• National guidelines for Case-costing
• For the year of 2000 we have 25 of Swedish
  inpatient care in the national Case-costing
  database
• Case-costing development in out-patient care,
  psychiatry and primary care

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The Case-costing process
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An example of a patient in a case costing
database - Fractures of femur
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A case-costing model

• 1. Identify the accurate total cost
• 2. Allocate indirect costs to the absorbing
  costs centres
• 3. Identify intermediate products and
  calculate their costs
• 4. Distribute costs to patients

in achieving quality in data
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Personal identification number

• All citizens of Sweden have a unique personal
  identification number, given to the person at
  birth
• The personal identification number has a general
  use, and is also used in every contact with
  Health care
• Gives us the opportunity to easily connect
  activities and costs to the right patient in our
  IT-systems

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IT-structure of a case-costing system
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IT-structure cont

• Data in the Case Costing system
• Patient characteristics
• Cost data
• Medical data

The case costing system
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Important issues for Case-costing

• IT-systems
• The need of national guidelines for Case-costing
• Identify the accurate total cost
• Allocate indirect costs to the absorbing
  costs centres
• Identify intermediate products and calculate
  their costs

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Why case-costing?

• Management support for clinics and hospitals
• Support to buyers of health care
• Benchmarking studies of costs and medical praxis
• Development of the DRG-system and calculating of
  weights and prices

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Management support

• Process oriented analyses of health care what
  do a certain diagnosis or treatment cost? Medical
  praxis outpatient/inpatient, activities e t c
• Management of a clinic, ex key indicators, costs
  for different patient groups
• Process budgeting, internal buy-sell agreements,
  product calculation

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The Kungalv study

• Aim of the project To improve results and
  quality with equal or decreased costs for
  patients with prostate disorders (DRG 336-337)
• Method Case-costing in combination with process
  analysis and Balanced Score Card.

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Results of the Kungalv study

• Cost reduction and improved quality by
• Better planning of surgery
• Better routines in different parts of the process
• Better information to the patients

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The Haematological project

• 1.To describe and calculate episodes of care.
• 2.To analyse possible means to reimburse
  Haematological care
• 3.To compare two Haematological clinics from a
  cost perspective
• 4. To do follow up of medical guidelines for
  multiple myeloma. The costs for the treatment
  will also be calculated

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Acute leukaemia 2000
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Costs and reimbursement outpatient care
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Haematological procedures
The R2 value is 0,87
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Results from the Haematological project

• Figures and facts about 12 haematological
  episodes of care
• Suggestion to a new reimbursement system for
  outpatient care. Suggestion to a new coding for
  patients in inpatient care.
• Analysis and cost calculation of the medical
  guideline program for multiple myeloma.

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Support to buyers of health care

• Costs for the treatment of different groups of
  patients
• Cost per geographical area
• Information about activities, medical praxis
• Price negotiations

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Neurosurgery a comparison in Stockholm
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Benchmarking studies of costs and medical praxis

• Internal benchmarking between clinics, wards
  and physicians
• Extern benchmarking between hospitals or
  different functions
• Comparisons over time

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Benchmarking key indicators Acute leukaemia
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Benchmarking hospitals Case-mix index
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The use of case-costing data from a
DRG-perspective

• Two main areas
• To test the DRG-systems cost-performance, how
  reliable are DRGs in predicting the patients
  resource utilisation?
• To calculate DRG-weights and cost-outlier limits

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Examples

• Method for calculating outlier limits and weights
• DRG-profiles
• Reduction in variance

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Exempel på ytterfallsberäkning för DRG 183
Medelvärde ca 9 Median 6
Q3k(Q3-Q1)
Ersättning ca 8 500 Kr
Q1
Q3
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Calculation of Weights - NordDRG

• Cost outliers are calculated and excluded (around
  5 of all cases)
• An average cost is calculated for every DRG-group
• The average cost for each DRG is related to the
  average cost for all inliers.
• Complementary rules for DRGs with low frequency

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DRG 122 Other circulatory disorders w ami W/O cc
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DRG 403 Lymphoma and non-acute leukemia w cc
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Reduction in variance
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Management of health care- What sort of data do
we need ?

• Individual data
• Case-Costing data
• Secondary Classifications
• Outcome data
• With this sort of data we can calculate
  productivity and efficiency of health care.

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Address on the web

The National Case-costing project
www.lf.se/sek/kpp.htm