Figures on health services ‘suspect’

Press, 2 August 1979, Page 2

Figures on health services ‘suspect’

PA Wellington Data in the Planning Coun-j cil’s report on social policies' in the 1980 s are suspect. The Hospital Boards’ Association said yesterday that the council's recommendations for the direction of a number of services such as “health and health care" offered what were apparently truisms in the most plausible way to arrive at an unassailable opinion which would meet with agreement in most quarters. The council had said: “Increasing evidence is becoming available to suggest that additional expenditure does not itself necessarily improve health. A majority of opinion, both medical and other, supports the view that imnrovements in the health jf the community can most

effectively be achieved by changes in lifestyles.” The association said: “Note should be made of the phrases ‘increasing evidence is becoming available,’ ‘necessarily’ and ‘a majority of opinion.’ “Where such assertions .and opinions are expressed, one would have thought that the authors of the report would have ensured the accuracy of the statistics and data produced, since the conclusions formed are based on data analysis and evaluation and not on the results of a detailed, scientific study that is subject to other control mechanisms. “It is, therefore, extremely disappointing to discover ‘that there is evidence that idata used and quoted by the I Planning Council are suspect. The report quotes an

O.E.C.D. study that says that New Zealand uses 71 per cent of its total public expenditure on health for hospitals. “This figure for "hospitals’ includes a number of items that are not included in the return of data from other countries, for example outpatients including much of accident and emergency costs, domiciliary services, day patients, and education of many staff groups. “Without these items, the percentage for New Zealand would be reduced and is likely to be closer to the average, though it is accepted that a high proportion of public health expenditure is on public hospitals. “The Planning Council alleges that the total public expenditure on health for hospitals is the highest figure for any O.E.C.D. country and compares with an average of 62 per cent (the average in the O.E.C.D. table was, in fact, 52 per cent). “The country with the highest percentage public hospitals expenditure compared with total public health expenditure is Sweden, with 73 per cent. Sweden’s figure was reduced by reallocating outpatients care from ‘hospitals’ to ‘medical services’ when the O.E.C.D. data were tabled for reporting purposes.

“However, this did not occur in New Zealand’s case, thus the direct comparison on reported figures is 73 per cent for Sweden, 71 per cent for New Zealand. “That the Planning Council report did not observe this, and note it, casts doubt on its findings,” says the Hospital Boards’ Association. “The O.E.C.D. publication itself indicated that the item ‘hospitals’ refers in principle to inpatient care only; however, in most countries, accounting practices do not allow a distinction between the various functions of hospitals so that day services are not often excluded. This introduces a regrettable but unavoidable bias in the analysis and means that the conclusions derived from heterogeneous sets of data must be heavily qualified.” Another part of the council report that caused the Hospital Boards’ Association concern said: “The proportion of total expenditure on health which is at present used for hospitals is too high. Reductions in hospital spending could be facilitated by a move away from predominantly institutional care to increased emphasis on community and home health care. This would be not only more cost effective, but would also be more satisfactory service for those concerned.”

Among some commentators there was a general belief that this opinion was valid, but in fact there was very little evidence on which to support the generality of the statement, the association said. “A number of studies indicate that treatment for a limited number of illnessesdiseases can be achieved equally as competently in I the community as in hospital,” the association said. “But is this evidence for the sweeping change of direction involved? Certainly the cost effectiveness on that scale has riot been tested, nor has the degree of satisfaction with community versus hospital treatment been well documented for many disorders. “It must be realised that referrals for hospital treatment come mainly from the primary sector. If that group felt treatment in hospital was unnecessary, surely the patient would not be referred? Eighty-five per cent to 90 per cent of all admissions to hospitals are Referred by general practitioners,” said the association.