Leung Eman, Guan Jingjing, Chu Amanda M Y, Ching Sam C C, Liu Yilin, Chen Frank Youhua
Department of Management Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China.
JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Front Public Health. 2024 Dec 24;12:1428130. doi: 10.3389/fpubh.2024.1428130. eCollection 2024.
Homecare, a cornerstone of public health, is essential for health systems to achieve the Sustainable Development Goal (SDG) of universal health coverage while maintaining its own sustainability. Notwithstanding homecare's system-level significance, there is a lack of economic evaluations of homecare services in terms of their system-wide cost-savings. Specifically, decisions informed by a joint medical-social budgetary perspective can maximize the allocative efficiency of assigning a diverse service mix to address the complex needs of the older adult population. However, little is known regarding which homecare service mix is most system-wide cost-effective when paired with which clinical profiles.
Valuation of homecare's complex interventions was performed under a generalized cost-effectiveness analysis (GCEA) framework with proportional hazard-adjusted metrics representing the common numeraire between medical and social care.
Instrumental homecare, on its own or combined with either one or both of the other homecare services, yielded the greatest cost savings compared to other services or the lack thereof. When expressed under a joint medical-social budgetary perspective, instrumental homecare can reduce medical costs of HK$34.53 (US$4.40) and HK$85.03 (US$10.84) for every HK$1 (US$0.13) invested in instrumental and instrumental-restorative homecare, respectively.
Instrumental homecare can increase hospitalization-free days among community-dwelling older adult and yield significant net system-wide cost savings. Thus, the current study demonstrated the feasibility of data-informed decision-making in system-wide resource allocation under a joint medical-social budget perspective.
居家护理作为公共卫生的基石，对于卫生系统实现全民健康覆盖的可持续发展目标并维持自身可持续性至关重要。尽管居家护理具有系统层面的重要性，但从全系统成本节约的角度对居家护理服务进行经济评估的研究仍较为缺乏。具体而言，从医疗 - 社会联合预算角度做出的决策能够最大化分配效率，从而为满足老年人群体的复杂需求分配多样化的服务组合。然而，对于哪种居家护理服务组合与哪种临床特征相匹配时在全系统最具成本效益，目前所知甚少。
在广义成本效益分析（GCEA）框架下，采用比例风险调整指标对居家护理的复杂干预措施进行评估，该指标代表了医疗和社会护理之间的共同计价单位。
与其他服务或无服务相比，器械性居家护理单独使用或与其他一种或两种居家护理服务联合使用时，节省的成本最多。从医疗 - 社会联合预算角度来看，每投入1港元（0.13美元）用于器械性居家护理和器械 - 恢复性居家护理，分别可降低34.53港元（4.40美元）和85.03港元（10.84美元）的医疗成本。
器械性居家护理可增加社区居住老年人的无住院天数，并在全系统产生显著的净成本节约。因此，本研究证明了在医疗 - 社会联合预算视角下，基于数据的决策在全系统资源分配中的可行性。
