Unto Häkkinen

A Comparative Application of Econometric Frontier and Dea Methods for Assessing Cost Efficiency of Finnish Hospitals

Economic recession and the government’s budget deficit are placing increasing pressure on hospitals in Finland to contain costs. The state subsidy reform in 1993 was expected to enhance productive efficiency by introducing competitive elements to health care. The reform allowed the municipalities to adopt a more active role as purchasers of hospital services as they became the budget holders of public health care money. Hospitals in Finland are owned by hospital districts, which are made up of federations of municipalities to which every municipality must belong. So far the role of hospital districts as local monopolies for producing specialised services has prevented the emergence of internal markets between the purchasers (municipalities) and the providers (Hakkinen 1995). Moreover, the purchaser cannot compare prices between hospitals because of the heterogeneity of the current pricing systems. However, purchasers, central government and tax-payers all began to express interest in the measurement of hospital efficiency after recent studies (Pekurinen et al. 1991, Kekomaki and Linna 1994, Linna and Hakkinen 1995) revealed that substantial differences could exist between hospitals in their productive efficiency.

Mortality and causes of death in older patients with schizophrenia

The aim of this study was to evaluate mortality and causes of death in older patients with schizophrenia in comparison with the general population. The mortality of patients experiencing relapse was also compared with those in remission.

Patients with very-late-onset schizoprhenia-like psychosis have higher mortality rates than elderly patients with earlier onset schizophrenia

In this register‐based study of schizophrenia patients aged 65 years or above, mortality and causes of death diagnosed at age of 60+ (very‐late‐onset schizophrenia‐like psychosis, VLOSLP) were studied in comparison with sex‐ and age‐matched general Finnish population. Standardized Mortality Ratios (SMRs) of VLOSLP patients were also compared with those of earlier onset (below 60 years) schizophrenia patients, and hazard of death was calculated between these patient groups.

Hospital volume affects outcome after total knee arthroplasty A nationwide registry analysis of 80 hospitals and 59,696 replacements

Background and purpose — The influence of hospital volume on the outcome of total knee joint replacement surgery is controversial. We evaluated nationwide data on the effect of hospital volume on length of stay, re-admission, revision, manipulation under anesthesia (MUA), and discharge disposition for total knee replacement (TKR) in Finland. Patients and methods — 59,696 TKRs for primary osteoarthritis performed between 1998 and 2010 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified into 4 groups according to the number of primary and revision knee arthroplasties performed on an annual basis throughout the study period: 1–99 (group 1), 100–249 (group 2), 250–449 (group 3), and ≥ 450 (group 4). The association between hospital procedure volume and length of stay (LOS), length of uninterrupted institutional care (LUIC), re-admissions, revisions, MUA, and discharge disposition were analyzed. Results — The greater the volume of the hospital, the shorter was the average LOS and LUIC. Smaller hospital volume was not unambiguously associated with increased revision, re-admission, or MUA rates. The smaller the annual hospital volume, the more often patients were discharged home. Interpretation — LOS and LUIC ought to be shortened in lower-volume hospitals. There is potential for a reduction in length of stay in extended institutional care facilities.

Psychiatric hospital admission and long-term care in patients with very-late-onset schizophrenia-like psychosis

In this register‐based study the rates and durations of psychiatric hospitalizations were compared between patients with very‐late‐onset schizophrenia‐like psychosis (VLOSLP, n = 918) and elderly patients with illness onset before 60 years (n = 6142). The proportion of patients ending up in long‐term care (LTC) or long‐lasting psychiatric hospital care (LLP) was also studied.

Chapter 10 Benchmarking Finnish Hospitals

One common feature facing diverse health care organisations is a need to compare performance across geographical areas, institutions or individual practitioners. In all health care systems, comparative data help the central government formulate policies for distributing central grants, clinical education, public health, research and tackling disparities. Good comparative data also provides an important resource for decision-making by local managers and clinicians. Through the process usually known as benchmarking, institutions can explore which of their peers are performing best, and seek out detailed qualitative and quantitative information on the context and processes contributing to good performance. Benchmarking also helps local managers set targets and rewards, and permits local electorates pass judgment on their local governments. The central theme of this chapter is to describe how the national hospital benchmarking system (BMS) was implemented in Finland, focusing on the use of BMS for managerial purposes and its impact on hospital care.

PATIENT CLASSIFICATION AND HOSPITAL COSTS OF CARE FOR ACUTE MYOCARDIAL INFARCTION IN NINE EUROPEAN COUNTRIES

This study contributes to the literature on the performance of diagnosis-related groups (DRGs) for acute myocardial infarction (AMI) patients by evaluating in nine countries the factors--in addition to DRGs--that affect costs or length of stay and comparing the variation that can be explained with or without DRGs. We evaluate whether the existing DRGs for AMI patients would benefit from additional patient-related and treatment-related factors that are found in administrative data across countries. In most countries, the set of patient and quality variables performed better than the DRG variables. Our results suggest that DRG systems in all countries could be improved by including additional explanatory factors or by refining the existing DRGs. Our results suggest that for AMI and possibly for other related episodes, a refinement of DRGs to include information on patient severity, procedures and levels of complications could improve the ability of DRGs to explain resource use. It seems possible to improve DRG-like hospital payment systems through the inclusion of episode-specific variables.

Change in antipsychotic usage pattern and risk of relapse in older patients with schizophrenia

The aim of this study was to explore the use of first (FGAs) and second generation antipsychotics (SGAs) in older outpatients with schizophrenia and schizoaffective disorder. Factors associated with schizophrenic relapses were also studied.