Comparisons of hospital output in Canada: national and international perspectives

Abstract

The break down of change in total expenditure in health care services into change in price level and change in output level is an important policy tool for analysing total spending over time and for the purpose of international comparison. The current cost-based approach in measuring health care output does not allow this price and output decomposition. In this paper we discuss various approaches in direct output measurement and propose an episodebased approach with quality adjustment which closely resembles the concept of output in the system of national accounts. This episode-based approach uses courses of treatment for each Case Mix Group and Day Procedure Group as the basis for output. Using data from the Canadian Institute for Health Information, we calculate an episode-based output index of the Canadian hospital sector for the periods 1996-2000 and 2003-2005. The result for the chained Fisher index shows that the quality-unadjusted index increases at an average annual growth rate of 1.6%. We expect that with the quality adjustment the actual rate is higher. We also offer recommendations for the implementation of quality adjustment and the establishment of a health satellite account.

A Systematic Review of Hospital Efficiency and Productivity Studies: Lessons from Australia, UK and Canada.

“…Australia, the United Kingdom and to some degree Canada each have a national mechanism to assess the e ciency of public hospitals (12,13,21). However, these national systems do not provide true estimates of e ciency and therefore cannot be used to robustly identify areas of ine ciency across decision making units.…”

“…Quantities measured are hospital inpatient and day surgery services with cost shares derived by using either the number of episodes for each major clinical category (MCC) or case mix group (CMG), or the number of episodes for each International Statistical Classi cation of Diseases and Related Health Problems, Tenth Revision, Canada clinical Chap. (13).…”

“…As noted by Ariste and Yu, the Canadian national accounting approach measures the total cost of inputs as total expenditures in publicly provided services, such as hospital care. This effectively means that total input costs are taken as total output, and it is therefore not possible to calculate the total factor productivity of the health sector (13,14). Ariste and Yu therefore employ an episode-based direction measurement method that closely resembles the concept of output in the system of national accounts.…”

How Does Sound Financial Management Impact Hospital Patient Satisfaction? A Linear Dynamic Longitudinal Study

“…'Patient satisfaction is a sensitive measure of a well-functioning health service system' (Heidegger et al, 2013(Heidegger et al, , p. 1165. This is especially important given that other measures of health care output are not well-defined (Aidemark & Funck, 2009;Ariste and Yu, 2017;Chang, 2015).…”