The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #53527

Mary A. Paterson, PhD, Abt Associates Inc., Suite 600, 4800 Montgomery Lane, Bethesda, MD 20814, Alfredo A. Sobrevilla, MD, MSc, PARSALUD (Programa de Apoyo a la Reforma del Sector Salud), Av. San Luis 2004 Ap Postal 5058. San Borja, Lima, Peru, and Alexander V. Telyukov, PhD, IHA, Abt Associates Inc, 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814, (301)913-0544, sasha_telyukov@abtassoc.com.

Purpose: Engage the Peruvian health care community in an evidence-based approach to improving health policy and managing acute care. Methods and data: The USAID-funded ‘Hospital Payment Experiment’ involving 7 hospitals from 5 regions, was conducted in Peru in 1998-2001. Hospitals changed patient reporting to introduce casemix groups. Over 75,000 cases were grouped into 469 Health Resource Groups (HRGs) using the U.K. NHS 3.0 Grouper. Standard methodology was employed to define facility average costs per case and costs per discharge. Results: The hospital payment experiment provided a modern system of clinical coding and case reporting. These tools improved the analysis of hospital utilization patterns, hospital costs, and the linkage between ambulatory and hospital care. For example high utilization was observed in maternal care, respiratory disorders, tuberculosis, and asthma, where improvement in ambulatory care could lead to significant reductions in hospital use. Significant inter-hospital cost variation, observed in most HRGs, provides guidance for choosing efficient hospitals in the nascent national system of competitive contracting. Policy Implications: Casemix data and patient reporting tools are being integrated into health research, resource allocation, and hospital contracting. Policymakers are now able to target improvements in resource use to high-volume, high-cost conditions where large savings can be expected from better case management, improved primary care, and reductions in hospital cost variations. The result of those strategies is more efficient and effective use of Peruvian hospital care resources, as well as improved primary and preventive care for Peruvian citizens.

Learning Objectives:

Learning objectives:
• Discuss the potential of health resource groups to provide evidence for targeted and effective health policy;
• Describe linkages between utilization of acute and primary care in chronic and infectious diseases;
• Articulate selective contracting strategies, based on comparative analysis of inter-hospital cost variations.

Keywords: Health Care Delivery, Health Reform

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.