Good story about hospital in the home in the NHS.
Plus the BMJ reference:
https://bmjopen.bmj.com/content/bmjopen/14/1/e081378.full.pdf
Ka pai, Jon. That was appreciated and timely. Greig
Interesting that they came to the conclusion that virtual care was not cost effective. On the surface you would think it is less expensive to treat people outside of the hospital setting. Difficult to understand if they really took all costs into consideration in calculating the daily rate, (e.g. capital construction costs, depreciation etc).
1 Like
The way I read this paper was the ward’s fixed costs were discounted from the calculation. The total operating costs of the virtual ward, both capex and opex, were then compared with the opex-only costs of the traditional ward.
The argument goes that the fixed costs of the traditional ward are sunk costs. So unless you’re going to close the ward or 100% repurpose the ward to some other budget line, these fixed costs are inelastic to innovation.
This is the stick finance often uses to beat innovation within existing models of care and services, so innovation becomes confined to new services. It certainly makes no sense if the measure of success is improved patient outcomes by restoration of function within the community.
I hope all this makes some sense and that I didn’t misread or misunderstand the paper.
2 Likes
Thanks for sharing that insight, Greig. Given the aging demographic is forecast to cost billions in developing additional hospital capacity, (currently approx. $29k per sqm to build hospitals) it seems to be a major omission vs. the potential to off-set building costs via virtual care.
2 Likes
Yeah it is interesting in terms of sunk costs.
Here we are already building hospitals in anticipation of this model of care (eg. Dunedin, Christchurch and Wellington hospital builds), ie. too small for the future so in theory it is worth us investing in this as an alternative as we save ourselves the future capital cost.
Part of the problem with that is operating vs capital in terms where the money comes from for that (capital charges are an interesting incentive/disincentive) and the sense “we get capital from the Treasury money tree”.
I found this article out of Scotland, interestingly framing it as community based wards, I particularly like this statement:
Unlike many ‘hospital at home’ models, which typically deliver healthcare under an acute-led structure, the Virtual Community Ward (VCW) model involves all members of the multi-disciplinary team and operates upstream of acute services.
2 Likes
A very interesting look at hospital versus in home virtual hospital care outcomes. One line that stopped me for a moment was the % increased risk per day of staying in a physical hospital as 4%. That certainly mounts quickly! Also I wondered about the social supports in the home for those admitted as virtual patients and how the social support impacted their care outcomes versus those admitted into a physical hospital where a feeling of isolation is often expressed and so psychologically impacting health. Just thinking out loud here but yes, a very interesting look at future possibilities for NZ.
Yes, interesting. I also noted the rate of readmission was higher for virtual care admissions…
Hey @jon_herries thanks for sharing - interestingly we were the tech provider for this project in Devon in the UK as featured in the article, so it was great to hear Harold’s experience in using Clinitouch.
Hospital in the home/virtual wards are really prevalent across the NHS now, and interestingly there’s lots of data and evidence to suggest that they are cost-effective when used in the right way. Yes, certain cohorts will have a larger burden on the healthcare system, but we’ve got some great evidence that they work and are effective across pathways including COPD, HF etc.
Welcome any questions from anyone about how it’s worked for us and any learnings we can share!
1 Like