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Workshop on measuring ouctomes and link between outputs and outcomes

Workshop on measuring ouctomes and link between outputs and outcomes. Giacomo Pignataro. Definitions. Output the product of actions and processes it can be identified with health care services Outcome the «consequence» of outputs

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Workshop on measuring ouctomes and link between outputs and outcomes

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  1. Workshop on measuring ouctomes and link between outputs and outcomes Giacomo Pignataro

  2. Definitions • Output the product of actions and processes it can be identified with health care services • Outcome the «consequence» of outputs it is generally identified with the change in health status what about patient satisfaction over and above the health effect ?

  3. The nature of the difference There is a direct link between outputs and (organizational) behavior: they are under the control of producers Outcomes are indirectly and partially controlled by producers, through the outputs

  4. Why is this difference relevant ? • It turns to be quite relevant when we want to evaluate the performance of providers in the use of the resources they manage (accountability issue) or whenever we consider ways of affecting such a performance (incentive issue) • The fundamental criterion for evaluating such performance is efficiency, that is no waste of resources in their use

  5. Therefore, given the nature of the difference between output and outcome, efficiency needs to be related to output • Outcome needs to be the object of effectiveness analysis: what is the achievement of the output of healthcare in terms of health gains, and how this achievement has been influenced by other factors

  6. Measuring outcomes • The measure of health outcome should indicate the ‘value-added’ to health as a result of contact with the health system • The fundamental difficulty is that it is rarely possible to observe a baseline, or counterfactual – the health status that would have been secured in the absence of an intervention • Although health status measurement is becoming increasingly routine in many health care settings, it tends merely to involve comparisons of health states before and after the intervention • Reliance on before/after measures will tend to undervalue the contribution of organisations that focus primarily on interventions designed to slow deterioration in health status rather than on those designed to make people better (Jacobs, Smith and Street, 2006)

  7. To reinforce the arguments for the need to separate the two concepts • separate judgment of what would otherwise be, ambiguously, conceived as interchangeable: health (gain) production efficiency and health care production efficiency. • even if it is theoretically conceivable to evaluate health care providers in terms of the contributions of their services to individuals health gains, the technical problems and the “costs” connected with a systematic evaluation of the marginal impact of the treatments provided by different suppliers, make this analysis extremely limited in practice.

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