Otsubo T et al, 2011: Evaluation of resource allocation and supply-demand balance in clinical practice with high-cost technologies
Otsubo T, Imanaka Y, Lee J, Hayashida K
Department of Healthcare Economics and Quality Management, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Abstract
RATIONALE, AIMS AND OBJECTIVES: Japan has one of the highest numbers of high-cost medical devices installed relative to its population. While evaluations of the distribution of these devices traditionally involve simple population-based assessments, an indicator that includes the demand of these devices would more accurately reflect the situation. The purpose of this study was to develop an indicator of the supply-demand balance of such devices, using examples of magnetic resonance imaging scanners (MRI) and extracorporeal shockwave lithotripters (ESWL), and to investigate the relationship between this indicator, personnel distribution statuses and operating statuses at the prefectural level.
METHODS: Using data from nation-wide surveys and claims data from 16 hospitals, we developed an indicator based on the ratio of the supplied number of device units to the number of device units in demand for MRI and ESWL. The latter value was based on patient volume and utilization proportion. Correlation analyses were conducted between the supply-demand balances of these devices, personal distribution and operating statuses.
RESULTS: Comparisons between our indicator and conventional population-based indicators revealed that 15% and 30% of prefectures were at risk of underestimating the availability of MRI and ESWL, respectively. The numbers of specialist personnel/device units showed significant, negative correlations with our indicators in both devices.
CONCLUSIONS: Utilization-based analyses of health care resource placement and utilization status provide a more accurate indication than simple population-based assessments, and can assist decision makers in reviewing gaps between health policy and management. Such an indicator therefore has the potential to be a tool in helping to improve the efficiency of the allocation and placement of such devices.
© 2010 Blackwell Publishing Ltd.
J Eval Clin Pract. 2011 Dec;17(6):1114-21. doi: 10.1111/j.1365-2753.2010.01484.x. Epub 2010 Jul 13
PMID: 20630009 [PubMed - indexed for MEDLINE]
Comments 1
This is an entirely health economic article that illustrates the availability and demand of MRI and ESWL in various parts of Japan (data from 16 hospitals). The authors used an OE-ratio, which is the quotient between observed units and expected units. The latter variable was based on the patient volume and known utilization of the specific device. There was a wide variation of OE-ratios in Japan from 0.43 to 2.18 with a mean (SD) of 1.18(0.41). This way of analysing the need of high-cost medical equipment such as ESWL devices might be useful for the people responsible for medical care and health economy as well as for manufacturers of this kind of medical equipment. The authors concluded that in Japan, in terms of ESWL, there was a 30% risk of underestimating the availability of ESWL.
Hans-Göran Tiselius