Healthcare management Informatie uit de workshops nodig voor opdrachten, daarna eraan werken. Wednesday after the workshop 1 am hand in assignment 3 turtorials What is health? - Absence of disease in physical and mental New definition: more individual, the ability to adapt and to self-manage, in the face of social mental and physical challenges of life Positive health perspective: - Multiple functions o Mental o Meaningfull o Quality of life o Participation o Daily functioning o Bodily function Different perspective then the previous, looks at what can we do, on some domains you can score high and on some there are balances Quadruple aim: - Control cost Satisfied providers: important after covid, there are still a lot of departments with burn out and leaving Improved population health Does management make a difference in Healthcare? - There are a lot of people doing hand on work In research they say management does help A lot of people in healthcare management have a healthcare background and not a business background What can we do? Challenges for healthcare management: (demographic issue in 2030 there will be more people old and less to take care of them, if 1/3 people need to work in healthcare after the peak there will be no jobs anymore) Instead of focussing on the best care a 7 or 8 should be enough Staff cannot grow - Demographic shift: increasing people that need care less people working in healthcare Pace of technological innovation Changing expectation Financial pressure Health crisis: covid (acute), obesity, a lot of them will be difficult What can we do? (examples)learn from other industries - Aviation safety: when somebody is scared to speak up even though they think it is a bad decision Car manufacturing: lean system Telecommunication: six sigma Hospitality: patient experience, Disney makes waiting fun car racing: reducing waiting time we can also learn from healthcare domain: - not only focussing on short-term, if I like surgeries but I should also tell the risks client relationship based on trust, the patients cannot do it themselves seek the evidence and follow it, physisians wont believe you without evidence stimulating working environment: there is also altruism to work in this field lifelong learning as a core value to be allowed to work in this field evidence based management (EBHC): - stronger then opinion this has been going on for 20 to 30 years o in the 90s there was a high variety in psycological outcomes trhee things that hinder EBHC - literature: not always ecxesible education: you learn it now but it becomes outdated, it takes a year to finish a report so the information you read today might be outdated already practice and academia: academia want to build a theory which takes more time framework for evidence: - theoretical: how and why it works empirical, actual use, why does this intervention work? What are they doing experiential: experience of actors practical important steps: - demand evidence: I found a new way …, then you would like to see evidence examine logic: what are they explaining? Am I following this? Criticize. Does it makes sense encourage experimentation: experiment, difficult in HC, there are ethical issues reinforce continuous learning: kind of build in, refresh education quite easy to follow but why doenst it happen: - benchmarking obsolete to knowledge personal experience: own experience are highly valued dogma: hype: lean HC, total quality etc. EBHC Elements: - people in field stakeholders context external evidence key barriers: - difficult to find, students have experience with this side effects: something you didn’t consider … Not apply to setting, “this is for car manufacturing, not for HC” Psychological factors, own experience highly valued Simply too much information, relates to the first point - Delay in application Patient is not population, statistics mean nothing to one person Reduces autonomy physician, this is normally high in HC “niet pluis” I feel something is wrong with patient Values vs evidence: values are more important (American elections) - Hoorcollege 5 Week 50 Video about hospital prices Paying for healthcare Who pays for your healthcare? Graph - 5000 per person in Netherlands 11% of our GDP spend on healthcare This has also grown trough the years During covid costs for care could be less because surgeries are postponed We spend a lot of money on healthcare – who pays for this? Most recent numbers - 5000 per inhabitant But actual is 120-135 with 385 personal risk But when you have a small care it can quickly be 1000,- Revenue collection: - How do we get the money o Individuals or employers o Mechanism> indirect vs direct o Voluntary, mandatory, .. o … Funding pooling - Let us share the money Purchasing - How do we spend money Ethical issues - Care needs to happen What kind of ethical considerations can you think of? - Everybody needs care Smokers Transplantation …. A whole list Health technology assessment We do something in the healthcare domain and what do we get QALY: if we want to invest it needs to change this 80.000 is the value of a high quality life year If you gain 1 year of healthy life then you are allowed to spend that money If you are above that then you are too expensive and might only be treated in a trial This is how we value life Example: Rules to have cost control, providers make them exactly for the price accepted How do we pay - Budget Fee of service Capitation Case-based payments No best way, pros and cons Global budget: - Fixed amount to serve people Prospective, not looking back Advantages: - Maximium of money Predictable, simplifies things Efficiency, incentive to cut cost Disadvantage: - Fee for service: Retrospective. Things happen in a year and we ask for the money - Might do more then you are supposed to Use of the service For patients it is attractive “give me everything” Incentives for physicians to perform health services High administrative cost Captitation General paticinar: fixed amount of money for the people being there Restrictive but very controlled Health prevention: if people are healthy they won’t come Select low-risk clients: they cost less, only works if you can choose the patients Case based reimbursement - You pay for what happens No deviation Predictability Unless you make a lot of mistakes Bundled payments: - You pay 1 time for a patient Advantage: incentive to collaborate and function well in network. You wont receive additional money if the patients comes back Now there is fee for service Everywhere it is expensive There is no best choice Value based healthcare - Different way of thinking A lot of hospitals have adopted this idea Video of porter didn’t watch Basic aspects of value based healthcare Vbch What is value? - eigen idee: Quality healthcare that helps the patient to get better van lecturer: formule: patient value= health outcome/ costs - effieciency what happens to patient proms and prems: outcomes and experience in the past the focus was on throughput time, number of mistakes… now you can make a mistake and a patient might still be happy healthcare providers don’t know the prices of care, costs are not really considers. Costs can be discussed. Example: giving everybody an eierbal when entering low cost and high experience Vbhc Paradigm shift, level shifts from how many patients to value to patients. To obtain this system the yellow thing - a lot of the hospitals are divided in departments to parts of the body, maybe switching to a department for broken legs … Bundle payment system: more attractive to be efficient and make less mistakes. Paying once Facilities are not that far apart in the Netherlands, in the usa this is different If healthcare is good in Utrecht then the traveling there is agreeable Building blocks ^ Fictitious example video In Netherlands: - Shared disicion making
