Elisa Hernández Torres

Efficiency and quality in health services: a crucial link

The relationship between quality and efficiency in the health sector is influenced by various conditions. The objective of this paper is to analyse the evolution of efficiency and quality in the Andalusian Hospitals during the years 1997–2004 and to study the association between efficiency and quality indicators. Hospital performance is analysed using data envelopment analysis and the Malmquist productivity index. Technical efficiency as well as healthcare quality increased during the analysed period. A weak association between efficiency and quality indicators exists. The results obtained rule out the existence of an efficiency–quality trade-off.

Cost-outcome analysis of joint replacement: evidence from a Spanish public hospital

Background and objectives: Efficiency-based healthcare decision-making has been widely accepted for some time, with cost per quality-adjusted life year (QALY) as the main outcome measure. Nevertheless, for numerous medical procedures, little data are available on the cost per QALY gained. The aim of the present study was to calculate the cost per QALY gained with primary hip and knee replacement and to compare the result with the cost per QALY for other medical procedures, as well as with the maximum threshold cost considered acceptable in Spain. Methods: We performed a prospective cohort pre-test/post-test study of patients undergoing primary hip or knee arthroplasty. Age, sex, and clinical variables were recorded. Functional status and quality of life were measured by means of the WOMAC and EuroQol instruments, respectively, before the intervention and 6 months later. The direct costs of the intervention were calculated, with length of hospital stay and the prosthesis as the main cost drivers. Results: A total of 80 patients, 40 from each intervention, were included in this study. Both functional and perceived health status improved after the intervention. The number of QALYs gained in the knee cohort was 4.64, while that in the hip cohort was 0.86. The total cost of knee replacement was lower (6,865.52 €) than that of hip replacement (7,891.21 €). The cost per QALY gained was 1,275.84 € and 7,936.12 € for knee and hip interventions, respectively. The calculations performed included a 6% discount rate for health outcomes, a 3% inflation rate for costs, and a success rate of 95% at 15 years. Conclusions: The costs of both knee and hip replacement were lower than the threshold of 30,000 € per QALY considered acceptable in Spain, and compared favorably with other medical and surgical procedures.

Coste de las técnicas de reproducción asistida en un hospital público

Objetivos: La mayoria de trabajos sobre costes de las tecnicas de reproduccion asistida (TRA) identifican el coste directo del procedimiento, sin considerar elementos como los costes estructurales o intermedios, de gran importancia. El objetivo de este trabajo es calcular el coste por proceso de las TRA realizadas en un hospital publico en 2003 y compararlo con los resultados de 1998 en el mismo centro. Metodos: El estudio se realiza en la Unidad de Reproduccion Humana (URH) del Hospital Universitario Virgen de las Nieves de Granada en 1998 y 2003. Partiendo de los costes totales de dicha unidad, y mediante una metodologia de distribucion de costes basada en la estructura de costes, calculamos el coste por proceso de las TRA realizadas en este centro, considerando los costes completos. Resultados: Entre 1998 y 2003, la actividad y los costes de la URH analizada evolucionan de forma distinta. El analisis de la actividad muestra la consolidacion de tecnicas, como la microinyeccion espermatica (ICSI) y la desaparicion de otras (ciclo sin reproduccion asistida e inseminacion artificial conyugal intracervical). En todos los procesos, los costes unitarios por ciclo y por embarazo disminuyen en el periodo analizado. Conclusiones: Se han producido importantes cambios en la estructura de costes de las TRA de la URH-HUVN entre 1998-2003. Mientras algunos procesos desaparecen, otros se consolidan con una elevada actividad. Los avances tecnicos y las innovaciones organizativas, junto con un «efecto aprendizaje», han alterado la estructura de costes de las TRA.

Ageing-related services as a key element for social cohesion

The aim of this article is to carry out an empirical analysis of certain factors related to dependence in Spain and additionally to study the intensity of the use of health resources by dependents. Age appears to be the main socio-demographic factor related to dependence, which confirms the need for measures to deal with the demographic changes taking place. Thus, providing services to cover long-term care could become an important instrument for social cohesion. Multivariate analysis does not reveal a strong link between the use of healthcare services and dependence that would justify the joint management of the two systems. This means that self-regulating management of dependence and healthcare systems may be adequate except in the case of severe dependency.