Substudy 9 Fact Sheet

Costs of Acute Care and Home Care Services (NA101-09)

Sponsor Organization:
Institute of Health Economics, Edmonton

Rationale/Goals:
This project is one of fifteen sub-studies of the National Evaluation of the Cost-Effectiveness of Home Care Project (NA101). Sub-study 9 examined the cost of home care relative to hospital inpatient care, and sought to identify additional opportunities for cost savings or for increasing system efficiencies.


Activities:
An observational study was conducted using Alberta provincial data for hospitals and home care for 1996 through 1998 to determine whether cases with home care were more or less costly than cases without home care. Three types of care episodes were identified: people who received care in hospital, those with inter-hospital transfers, and episodes which included both hospital and home care services. Data were analyzed by Case Mix Groups(CMGs - a classification system based on patients grouped by medical condition developed by the Canadian Institute for Health Information for funding and planning purposes). Inter-hospital transfer cases were excluded, as they would bias the results in some CMGs. The study used non-transfer cases and CMGs with high volumes of home care cases to determine the proportion of cases within individual CMGs which had home care, and the hospital and home care cost components for these cases. The study noted that one of the difficulties in analyzing issues relating to the economies of product scope is the absence of a classification system which includes both inpatient home care and acute home care.

Key Findings:
The project leaders identified the following outcomes:

• Conditions with the highest number of home care cases were in the musculo-skeletal, cardiovascular, digestive, and skin and tissue groups.
  
• Admissions with inter-hospital transfers were 1.75 more costly than those without transfers.
  
• Most combinations of hospital and home care were more expensive than hospital alone, but care needs (number of diagnoses) were also higher for those assigned to home care.
  
• Case severity is an important indicator of home care assignment. In other words, those in charge of allocating acute care patients to home care have deemed more severe patients to have a greater need for these services.

Implications:
The project leader indicated that the findings are significant because, in his view:

• The study identifies important determinants of home care, most notably, case severity. It also identifies new patterns of hospital to home care service.
  
• The study's results can be compared with those in the literature that find that the cost-effectiveness of home care as a substitute for acute care is not proven.

Evaluation Methodology:
As this project was analytic/evaluative in nature, please see the "Activities" section.

HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)

Language of Report:
English

• Executive summary
• Full report