texts, fact sheets, and summaries
Media releases, news coverage, and announcements
#300 - 895 Fort Street
Victoria, BC, Canada
Tel: (250) 384-2776
Fax: (250) 389-0105
Substudy 9 Fact Sheet
Costs of Acute Care and Home Care Services (NA101-09)
Institute of Health Economics, Edmonton
This project is one of fifteen sub-studies of the National Evaluation
of the Cost-Effectiveness of Home Care Project (NA101). Sub-study 9 examined
the cost of home care relative to hospital inpatient care, and sought
to identify additional opportunities for cost savings or for increasing
An observational study was conducted using Alberta provincial data for
hospitals and home care for 1996 through 1998 to determine whether cases
with home care were more or less costly than cases without home care.
Three types of care episodes were identified: people who received care
in hospital, those with inter-hospital transfers, and episodes which included
both hospital and home care services. Data were analyzed by Case Mix Groups(CMGs
- a classification system based on patients grouped by medical condition
developed by the Canadian Institute for Health Information for funding
and planning purposes). Inter-hospital transfer cases were excluded, as
they would bias the results in some CMGs. The study used non-transfer
cases and CMGs with high volumes of home care cases to determine the proportion
of cases within individual CMGs which had home care, and the hospital
and home care cost components for these cases. The study noted that one
of the difficulties in analyzing issues relating to the economies of product
scope is the absence of a classification system which includes both inpatient
home care and acute home care.
The project leaders identified the following outcomes:
- Conditions with the highest number of home care cases were in the
musculo-skeletal, cardiovascular, digestive, and skin and tissue groups.
- Admissions with inter-hospital transfers were 1.75 more costly than
those without transfers.
- Most combinations of hospital and home care were more expensive than
hospital alone, but care needs (number of diagnoses) were also higher
for those assigned to home care.
- Case severity is an important indicator of home care assignment.
In other words, those in charge of allocating acute care patients to
home care have deemed more severe patients to have a greater need for
The project leader indicated that the findings are significant because,
in his view:
- The study identifies important determinants of home care, most notably,
case severity. It also identifies new patterns of hospital to home care
- The study's results can be compared with those in the literature
that find that the cost-effectiveness of home care as a substitute for
acute care is not proven.
As this project was analytic/evaluative in nature, please see the "Activities"
HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)
Language of Report: