Transcript day cases become overnight stays

Kupu Taurangi Hauora o Aotearoa
Health Quality and Safety
Indicators
All the data, all the commentary
All in one place
GOVERN MEN T
GOALS
N Z TRIPLE
AIM
OUTCOMES
N ew Zealanders live longer, healthier and more
independent lives
Improved quality, safety and
experience of care
N ew Zealand’s economic growth is supported
Improved health and equity
for all populations
Best value from public health
system resources
Services throughout the patient journey, across the health and disability sector
SYSTEM-LEVEL IN DICATORS
Safety
Measure of
adverse events
Patient
experience
Measure of
patient
experience
Effectiveness
2. Amenable
(preventable) mortality
Functional health
outcomes scores
Equity
Stratification of
all measures
across
population
groups
Access/ Timeliness
Measure of
access to
primary health
care
Efficiency
8. Health care
cost per capita
9. % GDP spent
on health care
Measure of
workforce
wellness
CON TRIBUTORY MEASURES
Falls resulting in
harm in hospitals
Healthcare
associated infections
Measure of
surgical harm
Measure of safe
medication
management
Pressure injury
acquired in hospitals
1. Cancellations
of elective
surgery by
hospital after
admission
3. Occupied bed-days
aged 75+ admitted two
or more times per year
4. Day case turns into
overnight stay
5. Hospital readmissions
Mental heath postdischarge community care
Measure of cardiovascular
disease management
Stratification of
all measures
across
population
groups
6. Eligible
population up to
date with cervical
screening
7. Ageappropriate
vaccinations for
two-year-olds
Hospital days
during last six
months of life
Placeholder: measure of adverse
events
An overarching measure of adverse events across
the health sector will be used to summarise safety
(this could be a measure of harm-free care).
Under development: falls
Falls have been identified as the most commonly reported type of
harm in the annual serious and sentinel events report.
Falls are a part of the Commission's patient safety campaign.
This measure will align with the quality and safety marker for falls
.
Under development: healthcare
associated infections
Preventing healthcare associated infections is a part of the
Commission's patient safety campaign, including ensuring
good hand hygiene and preventing central line associated
bacteraemia (CLAB) in intensive care units.
This measure will align with the quality and safety marker
for healthcare associated infections.
For comparative purposes we have included
OECD/Commonwealth Fund data on postoperative sepsis.
Postoperative sepsis per 100,000 hospital discharges, 2009
Note: Age-sex-SDX standardized rates.
* 2008.
** 2007.
*** 2010.
Source: OECD Health Care Data 2012.
THE
COMMONWEALTH
FUND
Commentary
New Zealand and Australia appear to stand out
as having high postoperative sepsis rates based
on this international comparison. The
Commission's programme of work covers the
introduction of the surgical checklist which is
associated with reduction in postoperative
complications. The separate issue of surgical site
infection will be the subject of future work
programmes.
Under development:
Perioperative harm
Preventing perioperative harm is a part of the
Commission's patient safety campaign.
This measure will align with the quality and
safety marker for perioperative harm.
For comparative purposes we have included
data from OECD/Commonwealth Fund in
'Related information'.
Foreign object left in body during procedure
per 100,000 hospital discharges, 2009
Note: Age-sex-SDX standardized rates.
* 2008.
** 2010.
Source: OECD Health Care Data 2012.
THE
COMMONWEALTH
FUND
Commentary
• New Zealand is towards the higher end of the range of
foreign bodies retained following an operation. It is worth
noting that this is a very rare occurrence: fewer than ten
such cases are usually recorded each year in the
Commission's annual serious and sentinel events report.
This means that one or two fewer or more incidents (the
sort of change that reflects nothing other than ‘random
variation’) can change the relative position on this graph
substantially.
• Nevertheless, this is considered a ‘never event’ - something
that should never happen - in most countries, and as such
is worth reflecting upon.
Under development: medication
Ensuring safe medication management is part of the
Commission's patient safety campaign.
This measure will align with the quality and safety
marker for medication management.
Placeholder: pressure injury
Measures of pressure injury are being developed through
the Office of the Chief Nurse. Once routinely available we
intend to include these here.
Placeholder: patient experience
This is a vital but complex area. There is no currently available nationally
consistent data source for a measure to adequately address this area.
There are several options that we are considering for this section which include:
informed consent measure, patient experience survey, mental health KPI,
patient satisfaction survey.
This is so important that we intend to get this right first time with work planned
for early 2013.
Cancellations of elective surgery by
hospital after admission
This indicator measures the percentage of elective surgery (excluding maternity surgery)
cancelled by the hospital after the patient had been admitted.
The results provide insights into how close the system is running to capacity and a measure
of patient experience.
This indicator includes patients who were rebooked and admitted at a later date.
7-2008
8-2008
9-2008
10-2008
11-2008
12-2008
1-2009
2-2009
3-2009
4-2009
5-2009
6-2009
7-2009
8-2009
9-2009
10-2009
11-2009
12-2009
1-2010
2-2010
3-2010
4-2010
5-2010
6-2010
7-2010
8-2010
9-2010
10-2010
11-2010
12-2010
1-2011
2-2011
3-2011
4-2011
5-2011
6-2011
Percentage of operations cancelled
after admission by month, 2008-2011
7.0%
New Zealand
6.0%
Minimum Value
5.0%
Maximum Value
4.0%
3.0%
2.0%
1.0%
0.0%
Percentage of operations cancelled after
admission by year, 2008-2011
Rates of cancelled operations
3%
New Zealand
2%
Minimum
Maximum
1%
0%
2008
2009
2010
2011
Around 1 percent of operations were cancelled after admission. This proportion
has been relatively consistent across the country over the past four years. While
this appears to be a small percentage of total operations, it amounts to some
5,000 cancellations per year and represents a significant level of resource and
considerable disruption to patients.
There is considerable regional variation, with a nine-fold difference between the
highest four-year average level of cancellations (2.7 percent) and the lowest (0.3
percent).
The analysis above does not take into account the reasons for cancellation. It is
reasonable to suspect that there may be a seasonal impact on this indicator,
with medical acute conditions likely to dominate during winter meaning that
fewer beds are available for elective surgical cases, increasing the cancellation
rate. However, our monthly view shows little evidence of this
Deaths potentially avoidable
through health care (amenable
mortality)
This indicator is well-tested and accepted as a whole-of-system health outcome
indicator. It shows the extent to which available treatments are applied to
diagnosed conditions and shows the potential for gain in health outcomes. As an
internationally calculated indicator, it should, in theory, allow international
comparisons, although time spent collating consistent data sets slows down
calculation (the most recent data available relates to 2006–07).
Age-standardised amenable mortality
rates by year, 1997-2006
160
Deaths per 100,000 population
140
120
100
80
New Zealand
60
40
20
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Commentary
•
New Zealand's rate of amenable mortality has fallen notably over the last 10 years. This fall mirrors
the pattern seen in most high-income countries. During this period New Zealand has had one of the
higher mortality rates internationally, although it is not a particular outlier. For example, the
amenable mortality rate here remained around 30-40 percent higher than in Australia between
1997 and 2007, even as the rate fell.
•
While amenable mortality is probably the best measure that we have to consider the effect of
healthcare on mortality (other measures such as life expectancy are influenced by much broader
causes such as poverty, inequality, and social infrastructure as well as quality of healthcare) it does
have some weaknesses. It is dependent upon similar recording of details about patients in different
countries which cannot necessarily be guaranteed (although similar recording systems are used,
local practice in their interpretation can vary). The precision and complexity of calculating the
measure together with the need to get nationally consistent data sets makes this quite an 'out of
date' indicator, the most recent data available to us relates to 2006-07.
•
So we include a complementary measure, potential years of life lost alongside the amenable
mortality measure. This looks at deaths under the age of 70 and calculates the total years of life
lost through premature death. These data are available from the OECD up to 2010. Again New
Zealand has a relative high number of years of life lost, consistent with its relatively high amenable
mortality rate.
United States
United Kingdom
Denmark
New Zealand
Ireland
1997/8
Greece
140
Germany
160
Finland
Austria
Netherlands
Norway
Sweden
Japan
Italy
Australia
France
Deaths per 100,000 population
Countries age-standardised amenable mortality
rates for under 75 years
2006/7
120
100
80
60
40
20
0
NZ and Australian age-standardised amenable
mortality rates by year, 1997-2006
160
Australia
Deaths per 100,000 population
140
New Zealand
120
100
80
The continued difference between New Zealand and Australia is noteworthy.
However, care should be taken in the interpretation of these data. Tobias et
al, http://www.health.govt.nz/publication/saving-lives-amenable-mortality-newzealand-1996-2006, note that assuming that the higher amenable mortality
rate in New Zealand points to a less effective health system is flawed, "Once
corrected for differences in non-amenable mortality (as a proxy for these
underlying ‘structural’ factors), no difference in amenable mortality remains (or
a slight New Zealand advantage is seen in recent years), suggesting that the
two health systems are in fact performing at a similar level of effectiveness."
60
40
20
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
12000
10000
Mexico
Hungary
Estonia
Poland
Slovak Republic
United States
Chile
Czech Republic
Finland
France
Portugal
Belgium
Denmark
Slovenia
Greece
Korea
New Zealand
Austria
Germany
United Kingdom
Canada
Luxembourg
Ireland
Spain
Australia
Italy
Japan
Switzerland
Israel
Norway
Netherlands
Iceland
Sweden
Potential years of life lost, men, OECD countries, 2010
(or nearest available year)
Potential years of life
lost per 100,000 males
aged 0-69
8000
6000
4000
2000
0
6000
5000
0
Mexico
Hungary
United States
Slovak Republic
Chile
Poland
Estonia
New Zealand
Denmark
Belgium
United Kingdom
Canada
Czech Republic
France
Netherlands
Portugal
Germany
Ireland
Finland
Slovenia
Austria
Australia
Norway
Switzerland
Korea
Israel
Luxembourg
Greece
Italy
Sweden
Japan
Spain
Iceland
Potential years of life lost, women, OECD countries,
2010 (or nearest available year)
Potential years of life
lost per 100,000
females aged 0-69
4000
3000
2000
1000
Placeholder: functional
outcomes
Functional health outcomes scores
are being considered for this area.
Occupied bed-days for older people
admitted two or more times as an
acute admission per year
This indicator is a useful proxy for the effectiveness of the integration of
primary, acute and long-stay care. It illustrates effectiveness at avoiding
unnecessary admissions and ‘stepping down’ to less intensive forms of care.
For ease of international comparison, 'older people' is defined as all those aged
75 and over. We received very helpful feedback that a more useful indicator for
New Zealand would also include Maori and Pacific peoples aged 55 and over.
This is included in the 'Related information' section.
Occupied bed-days associated with 75s and over admitted
twice or more as an emergency per 1,000 population
2500
2000
1500
1000
NZ
Average
Minimum
500
0
2008/09
2009/10
2010/11
Commentary
•
Good integration of care services is an increasing priority for health systems in the
developed world, and an area of particular concern for ageing populations. Poorly
integrated care results in older people ‘falling down the gaps’ until the most
urgent, intensive and expensive care – an acute admission to hospital – is required.
A low number of occupied bed-days per capita and low regional variation are
desirable.
•
Compared with the UK (the other country where there is a consistent time series
for this indicator), New Zealand has around a 40 percent lower level of bed
occupancy and considerably less regional variation. The variation that exists
prompts the question, could this rate be improved further through widespread
adoption of the integration practices seen in areas with the lowest rates?
•
This indicator relates to ambulatory sensitive hospitalisations, a series of measures
that the Commission will explore in the 2013 Atlas of Healthcare Variation.
Related information
Occupied bed days per 1,000 population
Occupied bed-days associated with older people
admitted twice or more as an emergency
1800
1600
1400
1200
1000
800
600
NZ
Average
Minimum
400
200
0
2008/09
2009/10
2010/11
This variant of the measure includes Maori and
Pacific peoples aged 55-74. When tested during
our consultation process, respondents
considered this measure more appropriate for
New Zealand.
Occupied bed-days associated with 75s and over admitted
twice or more as an emergency in New Zealand and England
9000
8000
7000
6000
NZ Average
5000
NZ Minimum
NZ Maximum
4000
England Average
England Minimum
3000
England Maximum
2000
1000
0
2008/09
2009/10
2010/11
Comparison with England demonstrates that
New Zealand has notably low levels of bed
occupancy associated with older people
returning to hospital as an acute admission.
This is suggestive of relatively successful
integration of primary, hospital and aged care.
Occupied bed-days associated with people aged 75+
admitted twice or more as an emergency, per 1,000
population, by ethnic group
2500
Asian
Maori
Other
Pacific
2000
1500
1000
500
0
2008/09
2009/10
2010/11
Absolute comparisons between different ethnic
groups are complicated for this measure as the
age distributions are so different (a much
greater proportion of the total 'other' - primarily
NZ European - population is aged 75+) so we
present 75+ and 55+ for each ethnic group.
These show, however, higher occupied bed days
associated with Maori and especially Pacific
peoples populations, regardless of which age
group is considered.
Planned day case turns into
unplanned overnight stay
This indicator captures inconvenience to patients and disruption to planned
hospital flow.
The data may reflect an adverse incident in a procedure, unrealistic expectations
about which patients are suitable for day-case surgery or some local factor.
The indicator operates as a prompt for further enquiry and a measurement of
quality and efficiency.
% day cases become overnight stays
•
Nationally, the proportion of day cases that turn into unplanned overnight stays
has remained consistent over the last three years. Nevertheless, on the face of it,
this figure equates to up to 10,000 people a year who expected to be in and out of
hospital in a day who had to make an overnight stay.
•
This measure does not identify the reasons for an overstay and there may be a
very legitimate clinical reasons for keeping patients overnight. Hence, the results
need to be interpreted with caution. To help with this we show the change in
national intended day case rate in the next pane. Whilst there are some caveats to
this measure (we have excluded two DHBs from this calculation as their recording
of day cases is inconsistent compared to the rest of the country), there is no
obvious relationship between day case rate and day case overstay rate. In other
words the places with the highest day case rates are not those with the most
overstays.
•
We would anticipate variation in results between DHBs in relation to demographic
or geographic factors (for example, in rural settings a potentially longer distance to
hospital may affect ability to travel within the same day).
Related information
10.0%
July 2008
August 2008
September 2008
October 2008
November 2008
December 2008
January 2009
February 2009
March 2009
April 2009
May 2009
June 2009
July 2009
August 2009
September 2009
October 2009
November 2009
December 2009
January 2010
February 2010
March 2010
April 2010
May 2010
June 2010
July 2010
August 2010
September 2010
October 2010
November 2010
December 2010
January 2011
February 2011
March 2011
April 2011
May 2011
June 2011
% day cases become overnight stays
and % day cases
50.0%
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
#REF!
15.0%
#REF!
#REF!
#REF!
5.0%
0.0%
While day cases as a proportion of no-acute
hospital events have increased slightly since
2008, the level of day case overstay has
remained stable.
07/2008
08/2008
09/2008
10/2008
11/2008
12/2008
01/2009
02/2009
03/2009
04/2009
05/2009
06/2009
07/2009
08/2009
09/2009
10/2009
11/2009
12/2009
01/2010
02/2010
03/2010
04/2010
05/2010
06/2010
07/2010
08/2010
09/2010
10/2010
11/2010
12/2010
01/2011
02/2011
03/2011
04/2011
05/2011
06/2011
Day cases that overstay (numbers)
900
800
700
600
500
400
300
200
100
0
A number of stakeholders expressed an interest
in seeing this measure as a total volume of
activity rather than a percentage. In total there
are typically 600-700 day cases that end up as
overnight stays per month in New Zealand. The
number has increased slightly in recent years,
but this reflects an increase in the number of
day cases.
Relationship between day case overstays and amount of
activity attempted as a day case
60%
% DC overstay
50%
40%
30%
20%
10%
0%
% non acute admissions DCs
A number of stakeholders raised the question of
whether high overstay rates were associated
with high day case rates. In other words did
those hospitals with the highest levels of
overstay do so because they try to do more
work as a day case. The simple answer is 'no'.
There is no evidence for this. In fact the reverse
is closer to the truth, although the correlation
between the two measures is overall low.
Day case overstay rate by ethnic group, 2010-11
Percentage of daycases that overstay
5%
4%
66
5816
288
297
113
1060
3%
2%
1%
0%
Asian
European
Maori
Other
Pacific Island Unknown
There is no significant difference in the
proportion of day cases that overstay between
different ethnic groups. The figures on the graph
show the actual number of overstays in the
year, rather than the percentage of overstays,
allowing a comparison of the size of the overstay
issue.
Emergency readmission to hospital
within 28 days of discharge
This indicator is a proxy of both the care received in hospitals and the
coordination of care back to and within the outpatient setting.
While some readmissions are part of planned care and are desirable, others
may be an indication of a quality issue related to shortened length of stay and
premature discharge, inadequate care, lack of patient adherence to the care
regimen following discharge from hospital or poor integration of care.
% of hospital admissions followed by an acute
readmission within 28 days of discharge
14%
Readmissions
12%
10%
8%
6%
All NZ
4%
Minimum
Maximum
2%
0%
2007
2008
2009
2010
2011
Commentary
•
Readmission rates have consistently increased each year, rising from 8 percent in
2007 to 9.2 percent in 2011. The most recent rates internationally suggest that
New Zealand’s readmission rate is fairly typical although precise definitions of the
indicator vary between countries. England has shown a substantial increase in
readmission rates in the last 10 years, and these stand at around 11 percent.
Similarly, recent data from Canada suggest a readmission rate of around 8 percent.
•
This is a fairly crude indicator that does not take into account the nature of
unplanned readmission, or whether appropriate care available in the community
may have prevented the need for admission.
•
It is likely to be influenced by demographic factors, such as the proportion of older
people within a district population, and by existing levels of co-morbidity.
•
Nonetheless our analysis shows that there is not, as is often supposed, a direct link
between higher readmission rates and shorter length of stay.
Related information
Comparison of average length of stay with 28day acute readmission rate, by DHB, 2010-11
14
Average LOS (days) and
readmission rate (percentgae)
LOS
12
10
8
6
4
2
0
readmission rate
At first sight, and at a whole DHB level, there is
little evidence of a clear link between length of
stay and readmission rate. Further analysis
would be beneficial here including looking at a
smaller subset of conditions with higher
readmission rates.
Mental health post-discharge
community care
We have agreed with the mental health KPI
benchmarking group that this measure is the
most useful mental health measure to include in
this set. These data will be included soon.
Placeholder: CVD
Cardiovascular Disease (CVD) is a major killer in New Zealand, as
it is in many developed countries. The Commission has recently
explored management of CVD using triple therapy in its Atlas of
Healthcare Variation and we are considering what measure may
be most appropriate to use for this disease.
Placeholder: primary health care
access
We have considered a range of potential measures in this area, for
example: ability to enrol with PHO or babies enrolled with PHO in first
three months of life.
While this is still a placeholder, there is an OECD/Commonwealth Fund
measure relevant to this area which we present under 'Related
information'.
Related information
Average annual number of physician visits per capita, 2010
* 2009.
** 2008.
Source: OECD Health Data 2012.
THE
COMMONWEALTH
FUND
Eligible population up to date with
cervical screening
This indicator provides insight into cervical cancer prevention
and access to primary health care services.
Effective screening programmes allow early detection and
treatment of cervical precancer, lowering the rate of premature
mortality among women.
Percentage of women aged 25-69 screened
Cervical screening coverage, March 2012
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
NZ average
Minimum
Maximum
Screened in last 3 years
NZ average
Minimum
Maximum
Screened in last 5 years
Commentary
•
This measures the percentage of eligible women (aged 25-69 years) who have received a cervical
smear in the past three and five years. This measure has been part of the PHO Performance
Programme since 1 January 2011. However, we have used data collected and reported by the
National Screening Unit which is responsible for organising the Ministry of Health's National
Cervical Screening Programme, which includes health promotion, smear taking, laboratory analysis
of cervical smears, colposcopy and management of women with abnormal smear results.
•
In New Zealand, approximately 160 women develop cancer of the cervix each year, and about 60
women die from it. Some groups of women have higher rates of cervical cancer, including women
over 40, Māori, Pacific and Asian women, unscreened women and under-screened women.
•
The National Screening Unit estimate that without screening 1 in 90 women will develop cervical
cancer and 1 in 200 women will die of cervical cancer. In contrast with screening 1 in 570 women
will develop cervical cancer and 1 in 1,280 women will die of cervical cancer.
•
More information about the National Cervical Screening Programme and cervical screening itself is
available from http://www.nsu.govt.nz/current-nsu-programmes/908.aspx
Equity
• Given the fact that cervical cancer is a greater risk for women over
40, and Maori, Pacific and Asian women, screening rates across
different groups are of particular interest.
• Looking at screening rates by age group suggests that for women
between the ages of 35 and 60 there is comparatively little
difference in screening rates at both three and five year intervals.
However, screening rates drop quite quickly after 60 years of age.
• In terms of inter-ethnic variation it is notable that screening rate for
women in the 'other ethnic groups' (primarily these are NZ
European) remain significantly higher than for Pacific, Maori and
Asian women
Percentage of women aged 25-69 screened
Cervical screening coverage by age group,
March 2012
Screened in last 5
years
Screened in last 3
years
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
25-29
30-34
35-39
40-44
45-49 50-54
Age group
55-59
60-64
65-69
Cervical screening coverage by ethnic group,
March 2012
Percentage of women aged 25-69 screened
100.0%
90.0%
80.0%
Screened in last 5 years
Screened in last 3 years
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Asian
Maori
Other ethnic groups
Ethnic group
Pacific Island
International comparisons
This Commonwealth Fund chart based on OECD
data shows that New Zealand's rate of cervical
screening is very similar to that of the UK,
Canada and Norway. Being based upon a
registry rather than survey data, the New
Zealand figure is also more reliable than many.
In this instance the numbers on the graph show
the percentage of women screened.
Cervical cancer screening rates, 2010
Percent of women screened
Note: Norway, U.K., N.Z., Denmark and Australia based on program data; all other countries based on survey data.
* 2009.
** 2008.
Source: OECD Health Data 2012.
THE
COMMONWEALTH
FUND
Age-appropriate vaccinations for
two-year-olds
This indicator on the effectiveness of immunisation programmes provides a
perspective on public health programmes as well reflecting level of access to
primary health care services.
Children who receive the complete set of age-appropriate vaccinations are
less likely to become ill from the associated diseases.
Immunisations within 24 months, September 2012
Percentage of Children up to date with all
immunisation
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
NZ average
Minimum
Maximum
Commentary
• The vaccinations that fall within the two-year-old group are for
measles, mumps, rubella, diphtheria, tetanus, whooping cough,
polio, hepatitis B, pneumococcus and Haemophilus.
• High coverage is important to protect the health of both individuals
and whole communities. It reduces the spread of disease to those
who have not been vaccinated either by choice or because of
medical reasons, such as children who are immune compromised.
• Overall coverage levels are relatively high. The most recent data
suggest that around 90 percent of children have received the
complete set of age-appropriate vaccinations at age two, and that
regional variation is comparatively low.
Related information
Percentage of Children up to date with all
immunisation
Immunisations at 12 months, September 2012
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
NZ average
Minimum
Maximum
As a counterpoint to immunisations at two
years, we also present the same data for 12month-olds. This shows that the proportion of
12-month-olds immunised is very similar to that
of two-year-olds.
Equity
Interestingly, there is comparatively little variation between different ethnic
groups (ranging from 88 percent for Maori to 95 percent for Asian at 24
months, with very similar figures for 12 months). This however, is a recent
improvement. As overall rates of immunisation have increased, so too have
inequalities between different ethnic groups. As with screening the numbers
shown on the graphs give the denominator: in this case the number of
eligible children in each ethnic group. (Third graph courtesy of Ministry of
Health)
Immunisations at 24 months by ethnic group,
September 2012
100%
Percentage of Children up to date with all
immunisation
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
NZ European
Maori
Pacific
Asian
Other
Immunisations at 12 months by ethnic group,
September 2012
Percentage of Children up to date with all
immunisation
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
NZ European
Maori
Pacific
Asian
Other
Immunisation coverage at 24 month
milestone age by prioritised ethnicity
Coverage for each 12 month period
One Day meeting of Palmy Statisticians presented by Institute of Fundamental Sciences Massey University, Palmerston North, 28th October 2011
7
Equity
A similar pattern emerges for deprivation. There
is effectively no difference recorded between
immunisation rates for different deprivation
quintiles at 12 and 24 months. Again this
represents an increase in equity over the last
five years. (3rd Graph courtesy of Ministry of
Health
Immunisations at 24 months by deprivation
quintile, September 2012
Percentage of children up to date with all
immunisations
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1-2
3-4
5-6
7-8
Deprivation quintile
9-10
Unavailable
Immunisations at 12 months by deprivation
quintile, September 2012
Percentage of children up to date with all
immunisations
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1-2
3-4
5-6
7-8
Deprivation qunitile
9-10
Unavailable
Immunisation coverage at 24 month
milestone age by deprivation index
Coverage for each 12 month period
One Day meeting of Palmy Statisticians presented by Institute of Fundamental Sciences Massey University, Palmerston North, 28th October 2011
8
Health care cost/expenditure
We have combined two indicators to give a more nuanced
position on New Zealand health expenditure relative to the rest
of the developed world: health care cost per capita (US$
purchasing power parity per capita) and health care expenditure
as a proportion of gross domestic product (GDP).
Data include both public and private health expenditure.
Health care cost per capita (US$)
% GDP expenditure on health
Commentary
• New Zealand’s position on these indicators is interesting. On the
one hand, expenditure per capita is relatively low, with only
accession countries from the former Soviet Bloc and a number of
developing economies in the OECD list spending less per head on
health care. However, as a proportion of GDP, expenditure in New
Zealand is relatively high. What this implies is that while health care
is relatively cheap in New Zealand by international standards (and
its quality generally comparable with the rest of the developed
world), New Zealand is less able than many to easily increase what
it spends on health care.
• There is no 'right' level of expenditure for health care. It is certainly
not the case that more expenditure will necessarily drive better
outcomes, but equally, low spend does not necessarily equal
greater efficiency.
Pharmaceutical spending per capita, 2010
Dollars ($US)
Adjusted for differences in cost of living
* 2009.
** 2008.
Source: OECD Health Data 2012.
THE
COMMONWEALTH
FUND
• One area of expenditure where New Zealand stands
out internationally is in its reduced pharmaceutical
expenditure per capita. The role of PHARMAC in
helping to achieve this has been internationally
recognised as a major achievement.
• http://www.commonwealthfund.org/~/media/Files/
Publications/Fund%20Report/2012/Nov/1645_Squir
es_intl_profiles_hlt_care_systems_2012.pdf
Under development - hospital days
during last six months of life
• The logic of this measure is the belief that in most cases managing death
outside of the hospital environment is to be preferred and, therefore,
improvements in the management of death should be reflected in shorter
average in-hospital care.
• However, this measurement has considerable technical challenges in its
construction, and ethical considerations in its interpretation.