seslhd indicator sheets health volume 2 section 5 final ... · section 5: value for money: are we...

Section 5: Value for money: areValue for money: are we spending our dollars wisely?wisely?

A snapshotA snapshot

121Produced by the Strategy and Planning Unit, Directorate Planning and Population Health

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Contents Contents ‐‐ Section 5Section 5

Section 5. Value for money: Are we spending our dollars wisely?

We’re spending more on health 124

Where do the dollars go? 125

How efficient are we? 126

Our hospitals are increasingly busy 127

Emergency presentations increasing 128

Bed occupancy rates high 129

Older patients impact on activity 130

Utilisation of some procedures on the rise 131

Potentially preventable hospitalisations increasing 132

Preventable hospitalisations for acute conditions on the rise 133p

Diabetes increases hospital days for a range of conditions 134

122 Produced by the Strategy and Planning Unit, Directorate Planning and Population Health

5 V l f5. Value for money: are we spending our dollars wisely?y

nge? Health expenditure is continuing to rise. Factors contributing

to this rise including increasing rates of some chronic conditions and injuries (in particular diabetes and falls injuries), a growing and ageing population, continuing advances in medical treatment and technologies (which have increased life

r cha

n ed ca ea e a d ec o og es ( c a e c eased espans), and growing community expectations.

The shift in disease burden from acute to chronic and complex conditions, means that our system, which has historically focused on delivering acute inpatient care on an episodic basis, is struggling to meet the ever increasing

e for

an episodic basis, is struggling to meet the ever increasing demand. Bed occupancy rates are high and increasing at some of our facilities. Meanwhile, many hospitalisations are preventable, through improved and better coordinated prevention and care in the community.

Money used inefficiently is money that could have been used to

A c

ase

deliver better services, improve people’s well‐being and save lives. We have an opportunity to redesign our health system so that patients receive more timely care in the right setting, using the most appropriate interventions, and with that care clearly centred around the needs of patients and families. For people with chronic disease we need to ensure more coordinated and integrated care in the

A primary and ambulatory care setting.

Partnering with other agencies and service providers provides the opportunity for the District to build healthier communities through focusing efforts on coordinated and targeted primary prevention and early detection t t i

02

strategies.


We’re spending more on health

B 2000/1 d 2010/11 h h l h di i NSW i d b 105%Between 2000/1 and 2010/11, the health expenditure in NSW increased by 105%.This represents an annual growth rate of 7.5% and an estimated increase of $7,918 Million.

Health expenditure is steadily absorbing a higher proportion of NSW State expenditure. A decade ago, health expenditure comprised of 25% of NSW general government expenditure, as compared to 27% in 2009/10.

The continuing rise in health expenditure is associated with factors such as a high demandney

The continuing rise in health expenditure is associated with factors such as a high demand for services as a result of growing rates of chronic and preventable diseases, new treatments and technologies becoming available, and demographic factors such as a growing and ageing population.

r mon

Trend in Annual Expenditure by NSW Health 2000/1 to 2010/11

ue fo

r $’Million

12,000

14,000

16,000

Valu

2 000

4,000

6,000

8,000

10,000

Data source: NSW Health A l R t

‐

2,000

2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11

14124

Annual Reports

Produced by the Strategy and Planning Unit, Directorate Planning and Population Health

Where do the dollars go?Acute Services are by far the largest health expenditure Service Group. In 2010/11 Acute Services (Overnight and Same Day combined) consumed over $500 in every $1,000 of health expenditure in SESLHD.

The smallest health expenditure Service Group is Teaching and Research and Population Health. Of every $1,000 spent in SESLHD in 2010/11, $31 was for Teaching and Research and $17 was for Population Health programs.

South Eastern Sydney Local Health District will re‐orient health care delivery over the next five years to focus its efforts on reducing the demand for ne

y

over the next five years to focus its efforts on reducing the demand for expensive in‐hospital care through a networked and enhanced ambulatory and primary health care system and a range of other initiatives that reduce demand on hospital activity.

SESLHD Health Expenditure, by Service Group, 1 July 2010 to 30 June 2011 r mon

ue fo

r For every $1,000 of expenditure in SESLHD in 2010‐11, the following is spent in each of the Service Groups:

Acute $507

Outpatient $152

Sub‐acute $108

ValuEmergency $74

Mental Health $66

Primary & Community Health $45

Teaching & Research $31

Population Health $17

Data source: SESLHD Business

Population Health $17

Note: Population Health includes: Breast Cancer Screening; Childhood Immunisation Programs; Environmental Health; General Health Promotion/Education; HIV/AIDS and STI prevention, detection, control; Injury Prevention Programs; Needle Syringe Program; Other communicable disease prevention, detection and control; Other Disease Prevention, Detection and Control; Public Health System Support; Tobacco: Health Promotion and Regulation.

125

Data source: SESLHD Business Intelligence & Efficiency Unit


How efficient are we?Activity‐based funding (ABF) is a key component of shared funding arrangements between the Commonwealth and State/Territory jurisdictions and a key feature of the National Health Reform

SESLHD Activity Based Funding, variance from target, by Service Type, 2011/12

ney

yAgreement. ABF has been introduced to drive improvements in the efficiency and clinical performance of public hospitals and health services, and to provide an equitable and transparent method for allocating resources to facilities and services.

It means public hospitals are funded for each

2.0%

7.0%

r mon

It means public hospitals are funded for each episode of activity, based on the efficient price for acute, subacute, emergency and intensive care services provided to their patients.

The Independent Hospital Pricing Authority will set an “efficient price” at a national level for ABF hospital services. The State will continue to

‐8.0%

‐3.0%

men

t

dical

gery

rgery

cute …

days)

trics

ural

SNAP

alysis

ealth

ue fo

r pdetermine the District’s activity‐based funding targets.

Overall, in 2011/12 the SESLHD’s actual ABF activity was 1.0% above the target. The District is expected to absorb the additional costs incurred.

210 000

Emergency Dep

artm

Med

Other Surg

Planned

Sur

Non‐SNAP Sub‐a

ICU (occupied bed

d

Obstet

Proced S

Ren

al Dia

Men

tal H

e

Valu

0

70,000

140,000

210,000

Data source: SPaRC Report 331Note: SNAP = Sub and Non –

0

Target ActualNote: SNAP Sub and Non

Acute Patient


Our hospitals are increasingly busy

Hospital admissions for acute, subacute and mental health care are increasing at SESLHD h i l Thi d i d ihospitals. This trend is expected to continue.

Between 2010/11 and 2021/22 inpatient activity is expected to increase from:

• 100,000 to more than 120,000 separations• nearly 550,000 to more than 660,000 bed days

Sub acute care will have increased its share of separations and bed days ney

Sub acute care will have increased its share of separations and bed days.

Trends and projections of acute, sub acute and mental health inpatient activity at SESLHD hospitals

r mon

600,000

700,000

120,000

140,000

ue fo

r 300,000

400,000

500,000

600,000

60,000

80,000

100,000

120,000

Bed days

Separations

Valu

0

100,000

200,000

0

20,000

40,000

Data sources: FlowInfo v11.1, NSW Health’s acute & subacute projection tools:

aIM2010 V 1 6 & SiAM2010 V 1 1

Acute Sub acute Mental Health Bed days

127

aIM2010 V 1.6 & SiAM2010 V 1.1


Emergency presentationsincreasing

In 2011/12, there were nearly 200,000 Emergency presentations at SESLHD facilities.

Between 2006/07 and 2011/12 emergency presentations at SESLHD facilities increased by 16%, equating to an additional 26,600 presentations in 2011/12.

Nearly ninety per cent of the additional presentations were at Sutherland Hospital (an increase of 35%) and St George Hospital (an increase of 21%). ne

y

Trends in Emergency Department Presentations by SESLHD Hospital, 2006/07 to 2011/12r m

onrgency Presentations

ue fo

r

St George Hospital

Sutherland Hospital

100,000

150,000

200,000

No. of Em

e

Valu

Sydney Hospital

Sydney Eye Hospital

Prince of Wales Hospital

0

50,000

Data source: Health Information Exchange

via SESLHD Business

13

Intelligence & Efficiency Unit


Bed occupancy rates highIn recent years, bed occupancy rates at each of our hospitals have been above 90%, with the exception of the Royal Hospital for Women. In NSW, bed occupancy rates of up to 85% are considered appropriate, to allow for effective management of fluctuations in demand.

The occupancy rate is the percentage of days that a bed is actually occupied, averaged over a year. The standard way of reporting occupancy rates is to exclude certain unit types (see glossary for details).

Bed occupancy rates at each of our major hospitals have been fairly stable (or fluctuating) in recent years. The main exceptions are the consistent upward trends at ne

y

g y p pSydney/Sydney Eye Hospital and War Memorial Hospital.

r mon

Trends in Bed Occupancy Rates, by SESLHD Hospital, 2008/9 to 2011/12 (per cent)

lue f

orCALV POWH RHW STGH TSH SSEH WMH

80

90

100

Valu

Legend:50

60

70

Data source: Health Information Exchange via SESLHD Business

Legend:

RHW: Royal Hospital for WomenPOWH: Prince of Wales HospitalSSEH: Sydney/ Sydney Eye Hospital WMH: War Memorial HospitalSTGH: St George HospitalTSH: Sutherland HospitalCALV: Calvary Health Care

2008/09

2011/12

2008/09

2011/12

2008/09

2011/12

2008/09

2011/12

2008/09

2011/12

2008/09

2011/12

2008/09

2011/12

10129

Exchange via SESLHD Business Intelligence & Efficiency Unit


Old i i i iOlder patients impact on activityOlder people have a higher prevalence of co‐morbidities, and higher risk of complications,requiring more complex care and more resources.

Not surprisingly, older people are over‐represented in our hospitals. While only accounting for about 7% of the resident population, in 2010/11 people aged 70 years and older

ney

accounted for 38% of separations (more than 42,000 separations), and 48% of bed days (more than 280,000 bed days) at SESLHD facilities. Their average length of stay (ALOS) was 6.7 days, as compared to 4.3 days in all other age groups.

Activity in SESLHD hospitals, by age group, 2010/11

8 0

10.0

200 000

250,000

ays

In 2010/11, nearly three

r mon

0 0

2.0

4.0

6.0

8.0

50,000

100,000

150,000

200,000

Average LOS (days)

Separations & Bed dquarters of separations for

people aged 70 years and older were in ten Service Related Groups as shown in the diagram below.

ue fo

r

Top ten service related groups for separations among people aged 70 years and older in SESLHD hospitals by age group, 2010/11

0.0‐

00 to 15 years

16 to 44 years

45 to 69 years

70 to 84 years

85 and over

Separations Bed days ALoS

Valu 0 2,000 4,000 6,000 8,000 10,000 12,000

Rehabilitation

Cardiology

Non Subspecialty Medicine

Respiratory Medicine

Ophthalmology

Orthopaedics

Gastroenterology

Neurology

Non Subspecialty Surgery

Interventional Cardiology

Younger than 70 years 70 to 84 years 85 years and older

130

Data source: FlowInfo v11.1


l f dUtilisation of some procedures on the rise

Hip and knee replacements are both highly effective procedures, with large proportions of joint replacement patients experiencing significant pain relief and improved mobility, and hence much improved quality of life.

Over the last decade numbers of residents having hip and knee replacements increased by about 40%.

R t f th d id t i il t t NSW id t ney

Rates of these procedures among residents are similar to rates among NSW residents as a whole.

The need and demand for these procedures ‐ and the potential to positively impact on the quality of life of our residents ‐ is likely to increase further in the coming years, as the population ages.

r mon

e

Hip replacements (age standardised rates per 100,000 population)

Knee replacements (age standardisedrates per 100,000 population)

SESLHD rate

NSWNSW rate ue

for

150

200

150

200

NSW rateSESLHD rate

NSW rate

Valu

0

50

100

0

50

100

Data source: NSW Inpatients Statistics

10

Collection & ABS resident populations, accessed from HOIST


Potentially preventablePotentially preventablehospitalisations increasingSince 2003/04, Potentially Preventable Hospitalisations ‐ for Ambulatory Care Sensitive Conditions (ACSC) ‐ have been steadily increasing among SESLHD residents.

Ambulatory care sensitive conditions are those for which hospitalisation is considered potentially preventable through preventive care and early disease management, usually delivered through ambulatory and primary health care.

The top 8 conditions account for about 75% of all Potentially Preventable Hospitalisations among SESLHD residents.

ney

Trends in Potentially Preventable Hospitalisations among SESLHD residents, 2009/10

12000

16000

20000

r mon

0

4000

8000

Top 8 =75% of total

ue fo

r

Potentially Preventable Hospitalisations among SESLHD Asthma

Chronic Obstructive Pulmonary …

Cellulitis

Dental Conditions

Diabetes Complications

Dehydration & Gastroenteritis

UTI/Pyelonephritis

Valu

among SESLHD residents, 2009/10

Other

Influenza & Pneumonia

Angina

Iron Deficiency anaemia

Convulsions & Epilepsy

ENT Infections

Congestive Heart Failure

Acute

Chronic

Vaccine‐preventable

Data source: NSW Inpatients Statistics Collection & ABS resident

l ti d f HOIST

132

0 500 1000 1500 2000 2500populations, accessed from HOIST


Preventable hospitalisations for acute conditions on the rise

The sharpest increases have been for the top four acute conditions: urinary tract infections (UTI), dehydration & gastroenteritis, dental conditions, and cellulitis.

Potentially Preventable Hospitalisations for the acute category of Ambulatory Care Sensitive Conditions are increasing rapidly – they have increased by more than 30% since the mid‐2000s.

ney

250

Trends in hospitalisation rates for top 4 Acute Ambulatory Care Sensitive Conditions among SESLHD residents

UTI/ pyelonephritis

Dehydration & gastroenteritis r m

on100

150

200g

Dental conditions

Cellulitis

ue fo

r 0

50

Age standardised hospitalisation rates per 100,000

Valu

Data source: NSW Inpatients Statistics Collection & ABS resident populations,

133



Di b t i h it l dDiabetes increases hospital days for a range of conditionsDiabetes is a common co‐morbidity in hospitalisations for many conditions,

Diabetes as co‐diagnosis in hospitalisations for common cardiac conditions, and acutehospitalisations for many conditions,

including the top Acute Ambulatory Care Sensitive Conditions. For example, among residents diabetes is a co‐morbidity in at least 8% of admissions for cellulitis and 6% for urinary tract infections/pyelonephritis.

common cardiac conditions, and acute Ambulatory Care Sensitive Conditions,

residents, 2009/10

ney

10,000

15,000

Any Diabetes as 1st to 5th Diagnoses

No Diabetes as 1st to 5th Diagnoses

Diabetes is also associated with an increased length of stay (LOS). For example, the average LOS for admissions for dehydration/gastroenteritis among residents is 2.7 days. For the sub‐set of these admissions with diabetes as a co‐morbidity, the average LOS is more than double (5 6 days)r m

on

5,000

10,000

Separations

double (5.6 days).

About 10% of patients admitted with common cardiac conditions (coronary heart disease or heart failure) also have diabetes recorded as a principal or co‐morbid diagnosis.

ue fo

r 0

Diabetes as co‐diagnosis in hospitalisations for common cardiac conditions and top

4

6

8

All of the estimates presented here ‐related to the impact of diabetes on our patients and inpatient services ‐ are likely to be underestimates, given the known under‐recording of secondary co co‐diagnoses in hospital data in NSW.Va

lu

pAcute Ambulatory Care Sensitive Conditions,

residents, 2009/10

P j ti f NSW h it l id tif ge length of stay (days)

0

2

All seps Seps with Diabetes

Projections for NSW hospitals identify that the impact of diabetes will surpass all other conditions in the coming years.

Data source: NSW Inpatients Statistics Collection & ABS resident populations,

Averag

134



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