1437Rates of low value care in NSW public hospitals: variation between public and private inpatients

Costa, JDO; Pearson, S-A; Elshaug, A; Gool, KV; Jorm, L; Falster, M

1437Rates of low value care in NSW public hospitals: variation between public and private inpatients

Costa, JDO Pearson, S-A Elshaug, A Gool, KV Jorm, L Falster, M

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Publisher:: Oxford University Press (OUP)
Publication Type:: Journal Article
Citation:: International Journal of Epidemiology, 2021, 50, (Supplement_1)
Issue Date:: 2021-09-01

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Field	Value	Language
dc.contributor.author	Costa, JDO
dc.contributor.author	Pearson, S-A
dc.contributor.author	Elshaug, A
dc.contributor.author	Gool, KV
dc.contributor.author	Jorm, L
dc.contributor.author	Falster, M
dc.date.accessioned	2022-02-17T04:19:31Z
dc.date.available	2022-02-17T04:19:31Z
dc.date.issued	2021-09-01
dc.identifier.citation	International Journal of Epidemiology, 2021, 50, (Supplement_1)
dc.identifier.issn	0300-5771
dc.identifier.issn	1464-3685
dc.identifier.uri	http://hdl.handle.net/10453/154635
dc.description.abstract	<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Low value care (LVC) services have limited or no benefit to patients, and curtailing LVC can curb unnecessary spending and improve the quality of care. Some public hospitals in Australia have financial incentives to perform procedures for patients with private health insurance, yet little is known if there are differences in LVC between public and private patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We performed a retrospective analysis of New South Wales public hospital data from January 2013 to June 2018. We measured hospital-specific rates of five LVC services and compared rates within each public hospital by patient funding status (private or public), descriptively and using random-slope multilevel models.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Overall rates of LVC varied between services, ranging from 0.3 to 30.8 procedures per 1,000 eligible patients for hyperbaric oxygen therapy and vertebroplasty, respectively. There was large variation in rates of the LVC services between hospitals, and a few hospitals had higher rates of LVC among private than public patients. However, we found no consistent association between patient funding status and LVC services: private patients had lower rates of knee arthroscopic debridement than public patients (aOR:0.56) and higher rates of low value vertebroplasty for osteoporotic spinal fractures (aOR:1.08), hyperbaric oxygen therapy (aOR:1.53) and oophorectomy (aOR:1.77); all statistically non-significant.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Private patient funding may contribute to LVC in some public hospitals, but it was not consistently associated with higher rates of the five LVC services measured.</jats:p> </jats:sec> <jats:sec> <jats:title>Key messages</jats:title> <jats:p>Reducing LVC services requires investigating the role of health-system factors at both the global- and local-level.</jats:p> </jats:sec>
dc.language	en
dc.publisher	Oxford University Press (OUP)
dc.relation.ispartof	International Journal of Epidemiology
dc.relation.isbasedon	10.1093/ije/dyab168.195
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	0104 Statistics, 1117 Public Health and Health Services
dc.subject.classification	Epidemiology
dc.title	1437Rates of low value care in NSW public hospitals: variation between public and private inpatients
dc.type	Journal Article
utslib.citation.volume	50
utslib.for	0104 Statistics
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access	*
dc.date.updated	2022-02-17T04:19:30Z
pubs.issue	Supplement_1
pubs.publication-status	Published
pubs.volume	50
utslib.citation.issue	Supplement_1

Abstract:

Abstract Background Low value care (LVC) services have limited or no benefit to patients, and curtailing LVC can curb unnecessary spending and improve the quality of care. Some public hospitals in Australia have financial incentives to perform procedures for patients with private health insurance, yet little is known if there are differences in LVC between public and private patients. Methods We performed a retrospective analysis of New South Wales public hospital data from January 2013 to June 2018. We measured hospital-specific rates of five LVC services and compared rates within each public hospital by patient funding status (private or public), descriptively and using random-slope multilevel models. Results Overall rates of LVC varied between services, ranging from 0.3 to 30.8 procedures per 1,000 eligible patients for hyperbaric oxygen therapy and vertebroplasty, respectively. There was large variation in rates of the LVC services between hospitals, and a few hospitals had higher rates of LVC among private than public patients. However, we found no consistent association between patient funding status and LVC services: private patients had lower rates of knee arthroscopic debridement than public patients (aOR:0.56) and higher rates of low value vertebroplasty for osteoporotic spinal fractures (aOR:1.08), hyperbaric oxygen therapy (aOR:1.53) and oophorectomy (aOR:1.77); all statistically non-significant. Conclusions Private patient funding may contribute to LVC in some public hospitals, but it was not consistently associated with higher rates of the five LVC services measured. Key messages Reducing LVC services requires investigating the role of health-system factors at both the global- and local-level.

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http://hdl.handle.net/10453/154635