Biomedical subjects

C Beaver

Publications and source records attributed to C Beaver.

9 recordsLinked to original sources

PubMed2000

An assessment of the effects of casemix funding on hospital utilisation: a Northern Territory perspective.

This article is concerned with the methodological issues of assessing the effects of casemix funding on hospital utilisation. Time-series analysis and intervention analysis are proposed to ascertain the effects. It was found there had been a decline in average length of stay and number of bed-days, an increase in weighted separations for teaching and non-teaching hospitals, and no apparent increase of costliness in terms of a comprehensive casemix index. No evidence of decline in quality of care can be established in terms of readmission rates. The long-term effects of casemix funding, and specific issues in terms of the funding model used, patients and cost shifting between hospital services and community health services, remain to be studied.

Diagnosis-Related Groups↗

PubMed1998

Casemix-based funding of Northern Territory public hospitals: adjusting for severity and socio-economic variations.

The Northern Territory intends to make use of Australian National Diagnosis Related Groups (DRGs) and their cost relativities as the basis for the allocation of budgets among public hospitals. The study reported here attempted to assess the extent to which there are variations in severity of illness and socio-economic status which are not adequately explained by DRG alone and, if so, to develop a DRG payment adjustment index by use of routinely available data items. The investigation was undertaken by use of a database containing all discharges between July 1992 and June 1995. Hospital length of stay was used as a proxy for cost. Multivariate analysis was undertaken and it was found that several variables were associated with cost variations within DRGs. Stepwise multiple linear regression was used to develop a model in which 14 variables were able to explain 45% of the variations. Index values were subsequently computed from the regression model for each of eight categories of admitted patient episodes which are the intersections of three binary variables: Aborigine or non-Aborigine, rural or urban usual place of residence of the patient and hospital type (teaching or other). It is intended that these index values will be used to compute differential funding rates for each hospital in the Territory.

Aged↗

PubMed1997

Outcomes-based resource allocation for indigenous health services: a model for northern Australia?

Wide differentials continue to exist in mortality rates and other health outcomes between Aboriginal and non-Aboriginal Australians. In the Northern Territory (NT), where Aborigines make up 24% of the population, the all-causes age-adjusted Standardised Mortality Ratio for Aborigines compared to non-Aborigines has remained above 3 since the late 1970s, with significant regional variations. During 1995 an expenditure analysis was undertaken for primary health care (PHC) services in different regions of the NT and compared to mortality ratios. At the same time a method for needs-based funding was being developed which could replace the existing historical funding arrangements. In the first instance, the application of a simplified version of this Resource Allocation Formula (RAF) resulted in a significant shift of resources for new prevention program funding to regions of relatively high mortality and low per capita PHC expenditure. However, developing RAFs to redistribute at the margin within the NT is likely to generate further inequities between losing NT programs and counterparts in other states. If outcomes-based resource allocation is to be meaningful nationally, the reference point for the RAF should be national average PHC expenditure rather than existing state averages. There is a need for a combined approach to outcomes-based planning which takes into account both the equity arguments of resource allocation models and efficacy arguments to maximise health gains. Some of these arguments are explored in this paper.

Australia↗

PubMed1996

Clinical and postmortem outcome of "no-reflow' phenomenon in a patient treated with rotational atherectomy.

In the 77-year-old woman described, atherectomy of a circumflex artery with the Rotablator device was complicated by "no reflow." Ten days later, a 75% right coronary artery stenosis was successfully managed by balloon angioplasty. On the following day, acute closure of this vessel resulted in death. Gross examination of the heart showed features of recent posterior infarction, and microscopic study revealed atheroemboli in myocardial arterioles. We conclude that high-speed pulverization of atherosclerotic plaque can cause clinically significant emboli.

Aged↗

PubMed1996