Sustainability of the CONSENSO project

Transcription

1 Sustainability of the CONSENSO project Ippoliti R. November 8, 2017 Ippoliti, R., CONSENSO and sustainability - Ljubljana,

2 Table of contents Theoretical background 1 Theoretical background Targets Italian public health care system Elderly and falls 2 Empirical strategy Budget Impact Analysis (BIA) Break Even Analysis (BEA) 3 First step: target population Second step: FCNs cost Third step: budget impact and sustainability 4 Ippoliti, R., CONSENSO and sustainability - Ljubljana,

3 Research questions Theoretical background Targets Italian public health care system Elderly and falls The sustainability of the COmmunity Nurse Supporting Elderly in a changing SOciety (CONSENSO) project relies on social entrepreneurship (i.e., the entrepreneurial initiative of Community Nurses)... May such market in mountain areas exist? Is admissible the hypothesis that someone is interested in buying these services for the elderly population, who are resident in mountain areas? What about a public health care system? Are Local Health Authorities (LHAs) interested in these specific services? Ippoliti, R., CONSENSO and sustainability - Ljubljana,

4 Hypotheses and strategies Targets Italian public health care system Elderly and falls Main hypotheses: H1: Local Health Authorities (LHAs) are interested in Community Nurses and their services if the cost is sustainable. H2: A break even point in terms of falls prevention can define the necessary conditions to create a new market, i.e. the sustainability of the innovative care model. Main strategies: Focusing on Piedmont Region, two relevant methodologies have been proposed to test these hypotheses: the Budget Impact Analysis (BIA) and the Break Even Analysis (BEA). Ippoliti, R., CONSENSO and sustainability - Ljubljana,

5 Local Health Authorities (LHAs) Targets Italian public health care system Elderly and falls The functioning of regional systems in Italy (Fattore and Torbica, 2006). Ippoliti, R., CONSENSO and sustainability - Ljubljana,

6 Local Health Authorities (LHAs) Targets Italian public health care system Elderly and falls Source of data: Piedmont Region (2017) and Italian National Institute of Statistic (2017) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

7 Elderly necessities: falls Targets Italian public health care system Elderly and falls The frequency of falls increases with age and frailty level... Source: World Health Organization (2007) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

8 Risk factors Theoretical background Targets Italian public health care system Elderly and falls Falls occur as a result of a complex interaction of risk factors... Source: World Health Organization (2007) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

9 Protective factors Theoretical background Targets Italian public health care system Elderly and falls Protective factors for falls in older age are related to behavioural change and environmental modification... Behavioural change Healthy lifestyle is a key ingredient to protect older people from falling (e.g., non-smoking, moderate alcohol consumption, walking, playing an acceptable level of sport). Environmental modification Home modification prevents older people from hidden fall hazards in daily activities at home (e.g., installation of stairway protective devices, provision of lighting and handrails). Ippoliti, R., CONSENSO and sustainability - Ljubljana,

10 Costs of falls Theoretical background Targets Italian public health care system Elderly and falls The economic impact of falls is critical to family, community and society. Direct costs Health care costs (e.g., visit to an emergency department, hospitalization and rehabilitation). Among different cost items, hospitalization is the greatest cost, which ranges from US dollar 6,646 to 17,483 (Roudsari et al., 2005; Carey and Laffoy, 2005). Indirect costs Societal productivity losses (e.g., lost income), which could approximate US dollar 40,000 per annum (The University of York, 2000). Ippoliti, R., CONSENSO and sustainability - Ljubljana,

11 Study design Theoretical background Empirical strategy Budget Impact Analysis (BIA) Break Even Analysis (BEA) First step: target population Identification of mounatin areas, competent LHA and District; Estimation of elderly resident in mountain areas; Second step: CNs cost Estimation of CNs necessary for the planned intervention; Third step: budget impact and sustainability Budget Impact Analysis (BIA); Break Even Analysis (BEA); Ippoliti, R., CONSENSO and sustainability - Ljubljana,

12 Budget Impact Analysis (BIA) Empirical strategy Budget Impact Analysis (BIA) Break Even Analysis (BEA) The BIA is an essential part of a comprehensive economic assessment of heath care interventions used by who manage and plan health care budgets, such as administrators of national and/or regional health care programs (Sullivan et al., 2014). This model has been successfully used to estimate the expected economic impact of innovative pharmacological interventions (e.g., Bloudek et al., 2016) and can be a useful analytical tool to estimate the sustainability of an innovative health care model. The policy makers need clear information on the economic impact of extending the proposed new intervention to the whole target population and the BIA can provide a robust framework to estimate the expected economic burden. Ippoliti, R., CONSENSO and sustainability - Ljubljana,

13 Empirical strategy Budget Impact Analysis (BIA) Break Even Analysis (BEA) Key aspects considered in the proposed BIA Ippoliti, R., CONSENSO and sustainability - Ljubljana,

14 Budget impact model structure Empirical strategy Budget Impact Analysis (BIA) Break Even Analysis (BEA) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

15 Break Even Analysis (BEA) Empirical strategy Budget Impact Analysis (BIA) Break Even Analysis (BEA) The purpose of implementing a BEA is to determine exactly when you can expect the sustainability of the innovative care model. In other words, considering avoided costs due to a pro-active approach by FCNs, BEA is aimed at determining exactly when you can expect to cover all expenses with the proposed interventions. [ ] Total variable cost Break even pointi t t = i Avoided costi t where i represents the i-th health district considered at year(s) t. The regional health care system can achieve a break even point when the total avoided costs equal the total expenses of the innovative care model. No losses are supported at the break even point, that is to say, the innovative model is financially sustainable with that planned level of prevention. Ippoliti, R., CONSENSO and sustainability - Ljubljana,

16 BEA and reference values Empirical strategy Budget Impact Analysis (BIA) Break Even Analysis (BEA) Falls prevalence: Piedmont Region In Piedmont region, the prevalence of falls (30 days before the interview) among elderly people is equal to 8.39 percentage points. Falls prevalence: COSENSO According to preliminary results of CONSENSO, elderly who live in the lowest municipalities (i.e., cities at the bottom of the valley) have serious necessity of physical activity (i.e., without changing their life style, the fall risk might be really high). Falls cost Assuming a citizen broke one s hip, according to the clinical pathway adopted in Piedmont, the average cost reimbursed by a LHAs for the hospitalization and successive rehabilitation of this hypothetical patient is equal to Euro to 14, This is the key avoided cost adopted to estimate project sustainability, assuming the worst event after a fall. Ippoliti, R., CONSENSO and sustainability - Ljubljana,

17 Mountain areas in Piedmont Region First step: target population Second step: FCNs cost Third step: budget impact and sustainability Some data: 46 mountain areas 529 municipalities 191,977 elderly people Source of data: Piedmont Region (2002) and Italian National Institute of Statistic (2017) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

18 First step: target population Second step: FCNs cost Third step: budget impact and sustainability Descriptive statistics on LHAs and elderly people Source of data: Italian National Institute of Statistic (2017) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

19 First step: target population Second step: FCNs cost Third step: budget impact and sustainability LHAs districts and the expected scenario in 2023 Source of data: Italian National Institute of Statistic (2017) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

20 Planned intervention Theoretical background First step: target population Second step: FCNs cost Third step: budget impact and sustainability Authors assumed... the first home visit lasts 60 minutes, while the successive control home visits last half time; daily work on 7.12 hours, with 1 h in reporting activities; 1 day for the planning and 4 days for the home visits (with 228 working days per year); a rejection rate and an untraceable rate equal to 10 percentage points; every nurse is equipped with a car to reach elderly people. moreover... the first year, mapping of elderly (1 visit); the second year, follow ups (2 visits). Ippoliti, R., CONSENSO and sustainability - Ljubljana,

21 Human cost Theoretical background First step: target population Second step: FCNs cost Third step: budget impact and sustainability In microeconomic theory, the opportunity cost, also known as alternative cost, is the value of the choice of a best alternative cost while making a decision. In other words, a choice needs to be made between several mutually exclusive alternatives; assuming the best choice is made, it is the cost incurred by not enjoying the benefit that would have been had by taking the second best available choice. CNs opportunity cost According to national report (Conferenza Stato Regioni, 2015), the expected CNs wage has been assumed equal to ,00. Ippoliti, R., CONSENSO and sustainability - Ljubljana,

22 Transport cost Theoretical background First step: target population Second step: FCNs cost Third step: budget impact and sustainability Estimation of variable costs according to covered distance, assuming a city car (i.e., PANDA CROSS 0.9 TWINAIR 90CV - 4X4) and considering its cost, consumption (e.g., fuel) and maintenance (e.g., wheels). Source of data: ACI database (extraction: ) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

23 Total costs of the CNs Theoretical background First step: target population Second step: FCNs cost Third step: budget impact and sustainability Ippoliti, R., CONSENSO and sustainability - Ljubljana,

24 BIA: current vs new scenario First step: target population Second step: FCNs cost Third step: budget impact and sustainability Source of data: Ministry of Health (2017) Ippoliti, R., CONSENSO and sustainability - Ljubljana,

25 First step: target population Second step: FCNs cost Third step: budget impact and sustainability BEA: sustainability of the new scenario Source of data: proper elaboration according to collected data Ippoliti, R., CONSENSO and sustainability - Ljubljana,

26 Theoretical background Proposed hypotheses H1: Local Health Authorities (LHAs) are interested in Community Nurses and their services if the cost is sustainable. H2: A break even point in terms of falls prevention can define the necessary conditions to create a new market, i.e. the sustainability of the innovative care model. Collected results A reduction of falls prevalence with the worst expected outcome can support the sustainability of this innovative care model, i.e., a market with CNs as social entrepreneurs and LHAs as customers. Weaknesses Data availability (i.e., micro data). Ippoliti, R., CONSENSO and sustainability - Ljubljana,

27 Research agenda Theoretical background Italian market Sensitivity analysis (e.g., elderly older than 75 years); Formal vs. Informal market; European market Comparative analysis of different markets and their structures. Ippoliti, R., CONSENSO and sustainability - Ljubljana,

28 Thank you very much for your attention Ippoliti, R., CONSENSO and sustainability - Ljubljana,