Sunday, August 9, 2009

Fighting for health dollars!

I was having some ideas while listening to the first two lectures in Health Economics. I guess what I think now will change over the course, so I should write down what I believe at different stages. At the moment I think the whole government health budget should be divided in a different way (of course, they couldn't SUDDENLY change the proportions of various segments, but could work towards it, in my ideal universe!).

Firstly I think we should look at the people in the population and see how many are in various age segments, and what these segments will average out being over the next 5 to ten years.

Then we should look at what services were used by the age groups, divided initially into medical/pharmaceutical vs. surgical vs community health and public health/health promotion. Obviously we'd find that not many dollars are spent in community, public health or health promotion. There seem to be stacks of dollars spent on pharmaceuticals and I noticed that dental costs take 6.6% of the nation's health $$- strange since we don't tend to think of our mouths as using a lot of our general health resources or time.
Dept of Foreign Affairs and Trade describes the health system for lay persons and outsiders:

How they work out costings at the moment:
And here is the expenditure in public and private sectors:

I don't like DRGs (Diagnostic Related Groups) as they stand- although I may not understand them fully and therefore agree with them more than I think! However, I think that looking at the most prevalent illnesses for each age group and looking at the medical vs. surgical dollars spent on various procedures, rather than all admission costs, might result in a better idea of how to allocate funds in the future.
As well, I think that costs should be normalised/standardised for each age group and for the procedures and treatment packages most used so we can easily compare subgroups on a proportional rather than absolute cost basis.

Perhaps we look at the 50- 65 year old age group and find that there are a lot of cardiac-related surgical procedures and cardiac-related medications and GP consultations. We should look at what could possibly be "saved" by doing alternative things with the dollars at earlier ages and at how we might gradually reallocate the surgical dollars to prevention dollars. eg. we might see a lot of coronary artery bypass grafts (CABGs) and note that these cost a lot, whereas doing one or two stents on a younger person might achieve the same ends and give a longer average life after the procedure.
Giving a potential 25 years extra life to someone with a procedure at age 55 should be better than giving an extra 15 years at age 60 and each procedure and hospital stay ought to be cheaper on average, plus people are happier and have better mental health, saving some mental health dollars as well!

Therefore we need to use the Burden of Disease Statistics, look at getting the average number of years of life gained from various procedures/medical treatments, projecting the likely number of cases for the forward budget period and applying normed corrections for the proportions of the health budget to go to various health problem clusters. I noted that musculo-skeletal and respiratory diseases are priorities for the near future and that reducing cardiac disease and spending is also a continuing priority. There also looks to be a need to prevent acceleration in the obesity rate in order to avoid flow on costs to diabetes incidence/prevalence, cardiac disease strokes and falls. The community doesn't seem to have got the message about weight gain, especially in children and there don't seem to be huge innovative programs being introduced to remedy the situation- so this needs a lot of factoring in.

Anyway- rave rave. I'm just jotting here- will get down to specifics later.

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