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EUprimecare: Quality and Costs of Primary Care in Europe
September 2012, Gothenburg (Sweden)European Forum Primary Care
Grant Agreement no. 241595
Dr. Antonio Sarría-Santamera (ISCIII)Sonia García (ISCIII)
Eleonora Corsalini (UB)
• The goals of any healthcare system:• Deliver effective, safe, quality personal and non-personal
health interventions to those that need them, when and where needed, with minimum waste of resources
Access
Costs Quality
Background
• The Tallin Charter • Strengthening of health systems to improve people's health
but keeping equity.
• Primary Care • Basic structure of health system• Eliminating health disparities
Background
• Common framework to describe Primary Care models in the EU is not available
• Not yet developed a trans-national consensus on how to define quality of Primary Care
• Cost of Primary Care are not well identified in national accounting systems
Background
Objectives
• To contribute to improving the knowledge regarding Primary Care in Europe:
exploring the relationships that could exist between Quality and Costs of different models and systems of organizing and delivering PC across Europe
• Institute of Health Carlos III. ISCIII. Spain • Universität Bielefeld. UNIBI. Germany • University of Tartu. UTartu. Estonia • National Institute for Strategic Health Research. ESKI. Hungary • Országos Alapellátási Intezet. OALI. Hungary • Institute for health and Welfare. THL. Finland • Kaunas University of Medicine. KMU. Lithuania• Universitá Commerciale Luigi Bocconi. UB. Italy
Partners
Conceptual structure
Identify a methodology to measure the PC quality
WP 5 & 6
Identify a methodology to measure costs in PC
WP 3 & 4
WP 7
WP2
Evaluation of PC models
CO
OR
DIN
AT
ION
W
P 1
DIS
SM
INA
TIO
N
W
P 8
To measure the health quality in PC
To measure costs in PC
ORGANIZATION OF PRIMARY
CARE IN EUROPE
REGULATION
FINANCING
PAYMENTORGANIZATION
ORGANIZATIONAL BEHAVIOUR
• Costs
• Quality:
Approach
Work package 2: Evaluation of PC models in
EuropeMethodological Approach of a Classification System of PC Models in Europe : Germany, Spain, Estonia, Finland, Hungary, Italia and Lithuania.
WP2: Methodology
1. Literature review• Structure or process of PC in Europe• Control knobs: financing, regulation, payment, organization, and
organizational behavior
2. Selection of indicators => template design:1. 5 variables (Control knobs) to optimize healthcare systems results:
2. Range of services
3. Descriptive Analysis & Principal Component Analysis
FINANCING Mixed model
(Hungary)
BISMARCK SS(Estonia, Germany,
Lithuania)
BEVERIDGE NHS(Finland, Italy,
Spain)
7% Uninsured
10,6% Private Insurance18,8% Double coverage
Expenditure in HCas GDP
10,5%
6,1% 6,6%
24%
Expenditure in PC
5,7%
16% Double coverage
Descriptive analysis (I)
• Formal mechanisms to guarantee accessibility, equity and quality of healthcare
• Gate-keeping systems, except in Germany
• Facilities:• Mostly public: Finland, Spain, Hungary and Lithuania• Totally private: Germany, Estonia and Italy
• Clinical practice: • Integrated network: Finland and Spain• Solo and group practices: Germany, Estonia, Italy, Lithuania, Hungary
REGULATION
ORGANIZATION
Descriptive analysis (II)
• Process to monitoring and improving the quality of medical practice: • Quality management systems measuring clinical and no clinical
quality indicators• Clinical practices guidelines• Continuing education
ORGANIZATIONAL BEHAVIOUR
Descriptive analysis (III)
Provision of services through national/regional/local health systems (Yes/No)
Private voluntary health insurance (Yes/No)
Geographical distribution of PC services (Yes/No)
Professional income (Capitation/Salary/Fee for service/Out of pocket)
Gatekeeping for specialist (Yes/No) Type of facilities (Public/private) Type of clinical practice (Solo practice/Group practice/ Network)
Improvement programs & Quality management systems (Yes/No) Continuing clinical education program (Yes/No) Local adaptation of clinical practice guideline (Yes/No)
Financing
Regulation
Organization
Payment
Organizational behavior
Quantitative analysis (PCA)
Range of services
Results of Qualitative analysis
Based on a functional perspective, allowed to proposing 5 models:
1.Direct access to specialist
2.Referral required from GP, mainly solo-practices in PC3.Referral required from GP, mainly group-practices in PC
4.Health care centers5.Polyclinics
• Based on a functional perspective, allowed to proposing 5 functional models:
• Model 1: Direct access to any GP or specialist (Germany)• Model 2: Referral required from GP, mainly solo-practices in PC
(Hungary, Italy)• Model 3: Referral required from GP, mainly group-practices in PC
(Estonia, Lithuania)• Model 4: GPs working mainly in health care centres (Finland, Spain)• Model 5: Polyclinics (Shemasko). Not necessarily GPs at all
Results
Validation models of PC in Europe (24 countries EU )
COUNTRYGEOGRAPHICAL DISTRIBUTION
OF PRIMARY CARE SERVICES
National system
Regiona/local system
Multiple Insurers
Complementary & suplementary
Duplicative
ESTONIAFINLANDGERMANYHUNGARYITALY LITHUANIASPAINBELGIUMFRANCELUXEMBURGNETHERLANDSUNITED KINGDOMIRELANDPORTUGALDENMARKGREECENORWAYSWEDENSWITZERLANDAUSTRIACZECH REPUBLICICELANDPOLANDSLOVAK REPUBLIC
PROVISION SERVICES VOLUNTARY PRIVATE INSURANCE
Capitation SalaryFee for service
Out of pocket
ESTONIAFINALNDGERMANYHUNGARYITALY LITHUANIASPAINBELGIUMFRANCELUXEMBURGNETHERLANDSUNITED KINGDOMIRELANDPORTUGALDENMARKGREECENORWAYSWEDENSWITZERLANDAUSTRIACZECH REPUBLICICELANDPOLANDSLOVAK REPUBLIC
COUNTRYPROFESSIONAL INCOME *
*Predominance
COUNTRYGATEKEEPING TO
SPECIALISTS TYPE OF
FACILITIES*
Public Solo practice Group practiceIntegrated
networkESTONIAFINALNDGERMANYHUNGARYITALY LITHUANIASPAINBELGIUMFRANCELUXEMBURGNETHERLANDSUNITED KINGDOMIRELANDPORTUGALDENMARKGREECENORWAYSWEDENSWITZERLANDAUSTRIACZECH REPUBLICICELANDPOLANDSLOVAK REPUBLIC
TYPE OF PRACTICE*
* Predominance
COUNTRY
FORMAL QUALITY MANAGEMENT & IMPROVEMENT PROGRAMMES
CONTINUING CLINICAL EDUCATION
PROGRAMMES
LOCAL ADAPTATION OF
CLINICAL GUIDELINES
ESTONIAFINALNDGERMANYHUNGARYITALY LITHUANIASPAINBELGIUMFRANCELUXEMBURGNETHERLANDSUNITED KINGDOMIRELANDPORTUGALDENMARKGREECENORWAYSWEDENSWITZERLANDAUSTRIACZECH REPUBLICICELANDPOLANDSLOVAK REPUBLIC
Framework for classification of health systems based on PCMultidimensional => more complex => more realistic
Healthcare services provision Basic coverageGate-keeping
Private insurances Professional payment
Type of facilities Type of practice
Conclusions
Work package 3&4: Costs of Primary Care Systems
4 clinical vignettes representing the main areas of activity of PC: Acute care Chronic care Health promotion Prevention (vaccination)
Methodology Micro-costing
Methodology Macro-costing
• Actual costs: Real not estimated• Usual accounting principles and practices• Indicated in the estimated overall budget
IncludesPersonnel CostsDurable EquipmentConsumables and supplies identifiable
Work package 5&6: Quality of Primary Care Systems
• Focus Group Discussion :• Patients (n= 53)• Primary care professionals (n= 64)• 7 countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania, Spain.
• Helped to understand the views about quality in the different partner countries and to set a list of quality criteria.
• Non-clinical indicators for each criteria were identified from the literature review and prioritized by scoring according to importance and measurability.
Methodology Quality Indicators
60 Quality Indicators (aprox) selected to measure Quality of PC in Europe
Methodology Quality Indicators
Population Survey:
A sample of 3.020 persons25-75 years old7 countries participating in the projectDomains:
Socio-demographicSatisfactionSelf-perceived healthUtilization of servicesPrevention and health promotion interventions
Methodology Quality at the Population Level
Professional survey:
Medical records: Diabetes and blood pressure high14 indicators Specific approach for extracting data in each country
(sample)
Methodology Quality at the Clinical Level
Work package 5&6: QualityPopulation survey-Satisfaction Results
POPULATION SURVEY: SATISFACTION ITEMS
The way how available appointments with Primary Care (PC) suit your needs
The average waiting time for an appointment with PC to get non-urgent care
Waiting time in the waiting room in PC
Appropriate length of consultations with the PC doctor
Ease of talking about all your problems to the PC doctor
Listening skills of your PC doctor
Explanation of tests and treatments by the PC doctor
Preventive activities and services to prevent illnesses (vaccines. counseling. diagnostic tests) offered in primary care
Diagnostic test offered in primary care
Helpfulness of staff of primary care (not including the PC doctor. but nurses. patient service staff. etc.)
Overall satisfaction
POPULATION SURVEY: OVERALL RESULTS
Mean SD
The way how available appointments with Primary Care (PC) suit your needs 4.05 .993
The average waiting time for an appointment with PC to get non-urgent care 3.81 1.078
Waiting time in the waiting room in PC 3.69 1.080
Appropriate length of consultations with the PC doctor 4.15 .898
Ease of talking about all your problems to the PC doctor 4.25 .894
Listening skills of your PC doctor 4.27 .867
Explanation of tests and treatments by the PC doctor 4.13 .918
Preventive activities and services to prevent illnesses (vaccines. counseling. diagnostic tests) offered in primary care 3.86 1.034
Diagnostic test offered in primary care 3.96 1.004
Helpfulness of staff of primary care (not including the PC doctor. but nurses. patient service staff. etc.) 4.26 .832
Overall satisfaction with the attention provided by PC services 4.03 .911
The average waiting time for an appointment with PC to get non-urgent care 3.81 1.078
Waiting time in the waiting room in PC 3.69 1.080
Preventive activities and services to prevent illnesses (vaccines. counseling. diagnostic tests) offered in primary care 3.86 1.034
Diagnostic test offered in primary care 3.96 1.004
Ease of talking about all your problems to the PC doctor 4.25 .894
Listening skills of your PC doctor 4.27 .867
Helpfulness of staff of primary care (not including the PC doctor. but nurses. patient service staff. etc.) 4.26 .832
OVERALL SATISFATION BY COUNTRY
Country Mean SD
Hungary 4.39 .81
Italy 4.38 .77
Estonia 4.27 .86
Spain 3.93 .70
Finland 3.88 .94
Lithuania 3.77 .92
Germany 3.57 0.99
Mean=4.03
Estonia Germany Spain Lithuania Italy Hungary Finland0
10
20
30
40
50
60
70
80
90
100
0.724.02
0.46 1.64 0.70 0.47 2.572.42
8.27
2.557.03
0.70 1.86
5.84
15.70
30.50
18.10
25.53
11.86 12.35
17.52
31.88
40.90
61.25
44.26
33.72 28.44
48.83
49.28
16.31 17.6321.55
53.0256.88
25.23
Overall satisfaction with the attention provided by PC services (%)/Countries
Totally satisfied Very satisfiedSatisfied DissatisfiedVery dissatisfied
OVERALL SATISFACTION WITH THE ATTENTION PROVIDED BY PC SERVICES (%)
OVERALL SATISFACTION ACCORDING TO SOCIO-DEMOGRAPHIC CHARACTERISTICS
Categories Mean SD
Gender
Man 4.00 .90
Woman 4.05 .92
Age
25-34 3.91 .89
35-49 3.92 .94
50-64 4.05 .90
65-75 4.26 .84
City/town of residence
Rural (10.000 people or less) 4.09 .89
Urban (10.000 people or more) 3.99 .92
OVERALL SATISFATION ACCORDING TO CLINICAL CONDITIONS
Mean SD
Diabetes 4.24 .88
Hypertension 4.12 .93
Hypercholesterolemia 4.05 .89
Asthma 3.93 .00
Chronic bronchitis 3.95 .91
Mean=4.03
OVERALL SATISFACTION ACCORDING TO FINANCING FEATURES
SS NHS p value
The way how available appointments with Primary Care (PC) suit your needs 4.12 3.95 p<0.001
The average waiting time for an appointment with PC to get non-urgent care 3.85 3.77 p=0.004
Waiting time in the waiting room in PC 3.75 3.61 p<0.001
Appropriate length of consultations with the PC doctor 4.25 4.02 p<0.001
Ease of talking about all your problems to the PC doctor 4.33 4.14 p<0.001
Listening skills of your PC doctor 4.39 4.11 p<0.001
Explanation of tests and treatments by the PC doctor 4.19 4.5 p<0.001
Preventive activities and services to prevent illnesses (vaccines. counseling. diagnostic tests) offered in primary care 3.81 3.92 p=0.019
Diagnostic test offered in primary care 3.82 4.12 p<0.001
Helpfulness of staff of primary care (not including the PC doctor. but nurses. patient service staff. etc.) 4.35 4.11 p<0.001
Overall satisfaction (SD) 4.00(0.96)
4.06(0.84) p<0.301
Explanation of tests and treatments by the PC doctor 4.19
Preventive activities and services to prevent illnesses (vaccines. counseling. diagnostic tests) offered in primary care 3.81
Diagnostic test offered in primary care 3.82
ORGANIZATIONAL FEATURES
Countries
Gatekeeping and Integrated Network FinlandSpain
Gatekeeping Italy LithuaniaEstoniaHungary
No gatekeeping. no Integrated Network Germany
OVERALL SATISFACTION ACCORDING TO ORGANIZATIONAL FEATURES
Gatekeeping + Integrated Network
Mean (SD)No Gatekeeping
Mean (SD)Gatekeeping
Mean (SD)
The way how available appointments with Primary Care (PC) suit your needs 3.81 (0.94) 4.01 (0.92) 4.19 (1.01)
The average waiting time for an appointment with PC to get non-urgent care 3.60 (1.01) 4.00 (0.88) 3.88 (1.15)
Waiting time in the waiting room in PC 3.63 (0.98) 3.64 (1.02) 3.73 (1.14)
Appropriate length of consultations with the PC doctor 3.90 (0.86) 3.97 (0.92) 4.32 (0.87)
Ease of talking about all your problems to the PC doctor 3.97 (0.89) 4.26 (0.81) 4.38 (0.88)
Listening skills of your PC doctor 3.95 (0.87) 4.24 (0.84) 4.44 (0.83)
Explanation of tests and treatments by the PC doctor 3.90 (0.83) 4.08 (0.85) 4.26 (0.95)
Preventive activities and services to prevent illnesses (vaccines. counseling. diagnostic tests) offered in primary care 3.75 (0.93) 3.64 (1.01) 3.97 (1.08)
Diagnostic test offered in primary care 4.00 (0.85) 3.78 (0.96) 3.98 (1.08)
Helpfulness of staff of primary care (not including the PC doctor. but nurses. patient service staff. etc.) 4.01 (0.82) 4.35 (0.76) 4.37 (0.83)
Overall satisfaction (SD) 3.91 (0.83) 3.57 (0.99) 4.20 (0.88)
Gatekeeping + Integrated Network
Mean (SD)
3.81 (0.94)
3.60 (1.01)
3.63 (0.98)
3.90 (0.86)
3.97 (0.89)
3.95 (0.87)
3.90 (0.83)
3.64 (1.01)
3.78 (0.96)
4.01 (0.82)
4.00 (0.88)
Gatekeeping Mean (SD)
4.19 (1.01)
3.73 (1.14)
4.32 (0.87)
4.38 (0.88)
4.44 (0.83)
4.26 (0.95)
3.97 (1.08)
3.98 (1.08)
4.37 (0.83)
4.20 (0.88)
OVERALL SATISFACTION ACCORDING TO UTILIZATION
Categories Mean SD
Number of visits to GP
1 visit 3.96 .92
2-3 visits 3.99 .90
4-6 visits 4.03 .94
7-9 visits 4.15 .86
>9 visits 4.24 .86
Number of visits to specialist
1 visit 3.98 .94
2-3 visits 3.99 .93
4-6 visits 3.89 .94
7-9 visits 4.29 .74
>9 visits 4.06 1.02
Work package 7:Trade offs between PC Models, Quality
and PC expenditure
PERCENTAGE OF PATIENTS DIAGNOSED BY THEIR PC DOCTORS ACCORDING TO FINANCING FEATURES
Chronic Bronchitis Hypertension Hypercholesterolemia Asthma Diabetes 0
10
20
30
40
50
60
70
80
90
NHS SS
PERCENTAGE OF PATIENTS WHO ARE DIAGNOSED BY THEIR PC DOCTOR ACCORDING TO ORGANIZATIONAL FEATURES
Diabetes Hypertension Hypercholesterolemia Asthma Chronic Bronchitis 0
10
20
30
40
50
60
70
80
90
100
Gatekeeping & Integrated NetworkGatekeeping No Gatekeeping no Integrated Network
FRECUENCY OF PREVENTION AND COUNSELING ACTIVITIES ACCORDING TO FINANCING FEATURES
NHS SS NHS SS NHS SS NHS SS NHS SSWeight measure Cholesterol measure Blood sugar measure Blood preasure measure Smoking counselling
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1year
<1-2year
>2year
FRECUENCY OF PREVENTION AND COUNSELING ACTIVITIES ACCORDING TO ORGANIZATIONAL FEATURES
GTK+INY GTK No GTK/INT
GTK+INY GTK No GTK/INT
GTK+INY GTK No GTK/INT
GTK+INY GTK No GTK/INT
GTK+INY GTK No GTK/INT
Weight measure Cholesterol measure Blood sugar measure Blood preasure measure Smoking counselling
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1year
<1-2year
>2year
SELF-PERCEIVED HEALTH STATUS ACCORDING TO FINANCING FEATURES
95.6
4.4
NHS
89.5
10.5
SS
SELF-PERCEIVED HEALTH STATUS ACCORDING TO ORGANIZATIONAL FEATURES
96.1
3.9
GTK+INT
89.8
10.2
GTK
93.5
6.5
No GTK/INT
UTILIZATION ACCORDING TO FINANCING FEATURES
UTILIZATION ACCORDING TO ORGANIZATIONAL FEATURES
PERCENTAGE OF PATIENTS WHO ARE DIAGNOSED BY THEIR PC DOCTOR ACCORDING TO LEVEL OF EXPENDITURE
Diabetes Hypertension Hypercholesterolemia Asthma Chronic Bronchitis 0
10
20
30
40
50
60
70
80
90
100
LowMedium High
FRECUENCY OF PREVENTION AND COUNSELING ACTIVITIES ACCORDING TO LEVEL OF EXPENDITURE
Low Medium High Low Medium High Low Medium High Low Medium High Low Medium HighWeight measure Cholesterol measure Blood sugar measure Blood preasure measure Smoking counselling
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1year
<1-2year
>2year
SELF-PERCEIVED HEALTH STATUS ACCORDING TO LEVEL OF EXPENDITURE
88.1
11.9
Low
94.6
5.4
Medium
96.5
3.5
High
UTILIZATION ACCORDING TO EXPENDITURE LEVEL
Final remarks
The use of clinical vignettes in costing primary care services in
7 EU countries
3rd September 2012, EFPC Conference - Gothenburg
E. Corsalini, G. Fattore, A. Compagni
Overall task
To identify a methodology for cost measurement in primary care services and to apply it.
Challenging goal:• extreme variability in terms of professionals involved,
payment mechanisms, services provided across countries
• impossible to develop a one-fits-all method, but need to provide a common and defined framework
Chosen MethodClinical Vignettes= description of a common clinical
situation, followed by a synthetic questionnaire to be submitted to professionals
• solve the problem of the interpretation of identical questions
• are a common denominator in a context of extreme heterogeneity
• allow to describe how a certain clinical case is managed in primary care and to estimate all the resources consumed in the delivery
STEPS
1. To choose the vignettes
2. To translate the vignettes
3. To validate the vignettes
4. To submit the vignettes to primary care professionals
5. To collect questionnaires
6. To measure resources consumption in the delivery of services involved in the clinical vignettes
1. Choice of vignettes
Criteria taken into account:• Main areas of primary care systems:
- Disease prevention area- Care of acute but common problems- Care of chronic conditions- Health promotion services
• Primary care activities/services common to all the partners of the consortium
Vignettes
V1: A 70-year-old man in good health comes to the practice asking to be vaccinated against the seasonal influenza
V2: A 2-year-old boy comes to the practice with his mother. The day before the boy had developed cough with nasal discharge and had fever up to 38,2°C. The parent has noted a rattling sound in the child's chest. […] He has mild expiratory dyspnea. His breathing rate is 36 times per minute. […] He has atopic dermatitis but otherwise has been healthy.
VignettesV3: There is a 65-year-old woman among your patients, who has
been diagnosed with type 2 diabetes. She comes in for a follow-up visit: the tests from last week show that her HbA1c is 7%. She has no complications. She has been taking metformin 500 mg x2. You are her main primary care provider for the next 12 months.
V4: A young woman, aged 35, comes to the practice to get a certificate of “good health” for practicing a sport. She is in good health, she does sports, she has a good and satisfying job, she does not drink, nor uses drugs. But, upon you enquiring, she reveals that she has been smoking 20 cigarettes per day for the last 10 years.
STEPS
1. To choose the vignettes
2. To translate the vignettes
3. To validate the vignettes
4. To submit the vignettes to primary care professionals
5. To collect questionnaires
6. To measure resources consumption in the delivery of services involved in the clinical vignettes
4. Submission of vignettesVignettes have been submitted:
• personally, by interviewers from each country• to a group of professionals of the same kind (e.g., a group of
GPs, a group of paediatricians, a group of nurses): the number of the members for each group was 20-30 and different vignettes have been submitted to the same group
• through a written questionnaire: professionals of each group have been requested to answer the questions related to each vignette in writing
4. Submission of vignettesIn total, more than 200 professionals have been interviewed.
Professionals Number Professionals Number Professionals Number Professionals Number
HUNGARY GP 33 Paediatrician 52 GP 32 GP 29
ITALY GP 50 Paediatrician 23 GP 27 GP 50
FINLAND Nurse 5 GP 39 GP 38 GP 39
LITHUANIA GP 30 GP 30 GP 30 GP 30
ESTONIA Nurse 27 GP 23 GP 23 Nurse 24
GP 20 GP 20
Nurse 3 Nurse 3
GERMANY GP 37 Paediatrician 23 GP 33 GP 33
TOTAL 205 211 206 228
4
SPAIN GP 23Paediatrician 21
VIGNETTES
COUNTRY1 2 3
STEPS
1. To choose the vignettes
2. To translate the vignettes
3. To validate the vignettes
4. To submit the vignettes to primary care professionals
5. To collect questionnaires
6. To measure resources consumption in the delivery of services involved in the clinical vignettes
6. To measure resources consumption
• Data collected through questionnaires by each partner have been put together and synthesized in four different databases, specific per each vignette/questionnaire, by the Bocconi University team
• This last part of the exercise had two different purposes:
- to measure resources consumption in the delivery of certain primary care activities to which monetary values could be attributed;
- to collect data/information useful to carry out an analysis of variation of how the same case is managed within and between countries
6. To measure resources consumption
• Measuring resource consumption Methodology:
Time-Driven Activity-Based-Costing = it is a particular development of the better known Activity-Based Costing (ABC) that allows to design cost models in very complex contexts, such as service organizations
The TDABC requires two parameters: the time required to provide/perform the activity the unit cost of supplying capacity
6. To measure resources consumption: data collected
Each vignette was structured as to gather information about:
1. medical and administrative professionals directly involved in the service;
2. the amount of time spent in the activity by the professionals involved;
3. medical material directly used in the provision of the service;
4. medical material and other health care services consumed as a consequence of the service;
5. other medical professionals involved as a consequence of the service described in the vignette.
6. To measure resources consumption: data collected
Moreover, for each vignette, partner countries have provided:• cost of the professionals directly involved;• cost of administrative staff involved;• cost of the medical material directly used;• cost of the medical material and other health care services
consumed as a consequence of the service;• cost of other medical professionals involved as a consequence
of the service;• direct cost paid by patients for the provision of the service;• estimation of overheads costs.
SOME RESULTS FROM THE VIGNETTES
V2 – A sick 2-year-old boy:Professionals involved
Country Total cases PaediatricianGeneral
Physician Nurse SecretaryOther PC
professional
Hungary 52 100,00% 50,00% 28,85% 30,77%
Italy 23 100,00% 8,70% 21,74% 0,00%
Finland 39 100,00% 66,67% 33,33% 10,26%
Lithuania 30 100,00% 60,00% 10,00% 10,00%
Estonia 23 100,00% 69,57% 8,70% 17,39%
Spain 21 100,00% 47,62% 9,52% 0,00%
Germany 23 100,00% 0,00% 86,96% 0,00%
All countries 211 100,00% 46,45% 28,44% 12,80%
V2 – A sick 2-year-old boy:Time spent in the visit
Hungary Italy Finland Lithuania Estonia Spain Germany
Paediat./General Physician
Average time per case 13,9 16,3 13,8 15,7 14,7 13,4 12,7
Nurse
Average time per case 3,3 0,7 6,3 5,3 4,0 6,2 0,0
Other PC professional
Average time per case 2,5 0,0 0,8 0,4 0,7 0,0 0,0
Total time per case 19,8 17,0 20,9 21,4 19,3 19,6 12,7
V2 – A sick 2-year-old boy:Time - variability within countries
Hungary Italy Finland Lithuania Estonia Spain Germany
Paediat./General Physician
Min 5 10 1 1 1 6 5
Max 30 38 30 30 20 40 30
ST.DEV. 6,64 5,92 5,82 5,97 5,48 7,70 5,90
Average time per patient 13,88 16,35 13,85 15,67 14,65 13,38 12,65
V2 – A sick 2-year-old boy:Clinical behaviors
Hungary Italy Finland Lithuania Estonia Spain GermanyAll
countries
Pharmacological Treatment 94,23% 95,65% 87,18% 76,67% 65,22% 100,00% 95,65% 88,15% Categories of drugs Fever reducer 24,49% 54,55% 5,88% 26,09% 0,00% 42,86% 9,09% 23,12%Bronchodilator 81,63% 50,00% 97,06% 73,91% 80,00% 85,71% 100,00% 82,26%Antibiotics 18,37% 36,36% 2,94% 21,74% 20,00% 4,76% 0,00% 14,52%Anti-inflammatory 10,20% 36,36% 0,00% 4,35% 0,00% 0,00% 0,00% 7,53%
Hungary Italy Finland Lithuania Estonia Spain Germany All countries
Diagnostic tests 38,46% 30,43% 46,15% 50,00% 82,61% 0,00% 26,09% 40,28%
Specialist involved 40,38% 8,70% 64,10% 23,33% 17,39% 4,76% 0,00% 28,44%
V2 – A sick 2-year-old boy:Micro-costing
Hungary Italy Finland Lithuania Estonia Spain GermanyPaediat./General Physician € 3,86 € 26,83 € 14,13 € 4,17 € 5,05 € 16,24 € 59,51
Nurse € 0,74 € 0,27 € 3,01 € 0,79 € 0,58 € 5,34
Secretary € 0,55 € 0,67 € 0,45 € 0,02 € 0,06 € 0,04 Assistant/Trainee € 0,70 € - € 0,61 € 0,03 € 0,09 € -
TOTAL LABOUR COST € 5,86 € 27,78 € 18,20 € 5,01 € 5,78 € 21,62 € 59,51
DRUGS COST € 8,47 € 11,83 € 9,28 € 5,11 € 3,59 € 4,66 € 13,07
TESTS COST € 3,40 € 4,71 € 2,92 € 4,29 € 4,52 € - € 16,03
OUT-OF-POCKET € - € - € - € - € - € - € - TOTAL COST € 17,72 € 44,32 € 30,39 € 14,41 € 13,88 € 26,27 € 88,62
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Some costs data:Labour cost (in PPP)
Hungary Italy Finland Lithuania Estonia Spain
General Physician average cost in PPP
per year € 18.818 € 115.354 € 64.617 € 18.549 € 23.106 € 84.675
Paediatrician average cost in PPP per year € 18.818 € 129.910 N.A. N.A. N.A. € 72.148
Nurse average cost in PPP per year € 12.255 € 37.827 € 34.185 € 14.287 € 14.144 € 51.423
Secretary average cost in PPP per year € 4.821 € 29.098 € 27.676 € 7.811 € 7.180 € 22.972
Assistant/Trainee average cost in PPP per year € 9.720 € 92.601 N.A € 7.811 € 14.144 N.A
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