Dr. Giampiero Favato presented at the University Program in Health Economics Ragusa, 26-28 June 2008
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There are also aspects of the systems in Colombia, Australia and Spain that fit this model. However, this model is not frequently found.
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State
State
Regions
Regions
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ITALY
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ITALY
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To allocate funding to different subordinate purchasers, the responsible organisation needs to know:
How many people are in each separate pool; How ill these people are likely to be; How much it will cost to treat their illnesses efficiently, in the light of either current practice or guidelines and protocols on treatment.
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Allocative equity
Horizontal equity is concerned with equal treatment of individuals who are equal in all relevant respects. Vertical equity is concerned with unequal treatment of individuals who are unequal in some relevant respects.
If the risk pooling system shifts a lot of resources towards those with the worst health, these resources may be unable to achieve major gains in health, for example, because such patients are close to death; Funding will then be less readily available for routine treatments which can extend quality of life.
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Maximise the health of the worst off. Society should aim to maximise the position of the worst off in distributing income and opportunity (termed the Difference Principle).
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Study objective
The primary objective of this study was to discuss the adoption of a knowledge-based capitation model (ASSET, Age/Sex Standardised Estimates of Treatment) and its implications for Italian healthcare policy makers.
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Metodhs
Integration of 2 databases:
Pharmaceutical individual costs Personal data
Sample: 3,175,691 Italian residents Timeframe: 24 months/12 analysed (October 04/ September 05) Data collected:
Age Sex Drugs prescribed (ATC 5 level) Cost paid by the Italian National Health Service (SSN)
Data privacy: all personal information were replaced by an univocal numerical code
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ASSETs mean cost by age group and standardised weights for overall prescribing.
Mean cost (Euro) Males Females 41.37 35.72 36.11 31.59 43.66 37.53 44.93 40.94 52.75 62.75 80.89 90.52 146.20 149.62 300.88 277.40 505.77 431.13 652.75 481.20 196.13 195.12 Standardised weights Males Females 0.21 0.18 0.18 0.16 0.22 0.19 0.23 0.21 0.27 0.32 0.41 0.46 0.75 0.76 1.54 1.42 2.59 2.20 3.34 2.46 1.00 1.00
Age group < 14 0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 >75 Total
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Ageing
Differently from what observed in UK, infants of age 0-4 years consume fewer medicines than the next group age (5-14) On average, a 75 year old male consumes annualy 12 times more medicines than a 25 year old (8 times for a female) Individuals ageing >65 years (22% of the population) consume 56% of the national public prescribing budget
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25-34
35-44
45-54
55-64
65-74
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Conclusions
The ASSET model is a knowledge-based tool, useful to support healthcare governance to equitably allocate prescribing funding to regional authorities The major limitation of demographic adjusted healthcare cost models is represented by their tendency to lose their explanatory power when the subset of population examined gets smaller The identification of a robust model capable to identify the drivers of individual variances should be the objective of further research The ASSET age/sex weightings should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing resources in conjunction with historic utilisation and cost data.
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