The Municipality of HolstebroCost-effective healthcare solution

Identification of expenditure and potential cost reductions contributes to solving the growing level of expenditure on treatment and care of elderly citizens.

The Municipality of Holstebro received an overview of expenditure and potential cost reductions by developing an intermediary unit within the framework of the municipality.

The Municipality of Holstebro is a medium-sized Danish municipality with approx. 60,000 inhabitants. A conservative projection of the municipality’s healthcare expenditure has shown an increase of DKK 104 million annually towards 2020. The increase in expenditure on health is a result of changes in the demographic composition of the municipality’s population as well as a growing level of expenditure on municipal co-financing of hospital services and health insurance services.

The municipality experienced an increasing need for home care and home nursing care to the elderly group of citizens in the population. This need is typically on the rise following hospital admissions. Furthermore, the municipality experienced an increased hospital use, including acute admissions and outpatient controls.

Going forward, a reduction in bed capacity in the hospital sector will also entail that the municipality must be able to discharge citizens faster and offer them accelerated rehabilitation programmes with the objective to restore the level of function and ability to self-care.

Key reasons

• Changed demography, more elderly people
• Increasing healthcare expenditure
• Increased care needs among elderly people
• Need for healthcare solutions at the lowest effective cost level
• Changed division of labour between sectors going forward

Diagnosis

Based on these challenges, the Municipality of Holstebro identified cost-effective solutions which partly ensure early and less cost-heavy interventions, a reduction in elderly citizens’ care needs, a cutback in the number of unnecessary hospital admissions, a shortening in length of necessary hospital admissions, and a reduction in the number of hospital visits in general.

The financial rationale behind a cost-effective healthcare solution that is capable of responding to the municipality’s challenges should thus:

• Ensure transition of citizens “downwards” in needs for support
• Minimise the number of citizens with hospital visits
• Ensure substitution of hospital visits with less cost-heavy as well as more targeted initiatives

Solution

Based on Norwegian and Scottish experience with responding to the above-mentioned challenges in relation to establishing intermediary units and acute outgoing function, the Municipality of Holstebro chose to focus on identifying cost effectiveness. Implement Consulting Group has in cooperation with relevant persons from the municipality analysed, which hospital activity can either be avoided or substituted as well as which types of citizens the municipality can discharge faster to an intensive 24-hour rehabilitation offer.

Based on international experience and studies, it has been specified and forms the basis for the calculations, which other prerequisites, including requirements for staffing, competences, equipment etc., the realisation of the positive effects of the solution requires.

Results

The analysis showed that over a 5-year period, it is possible to reduce expenditure by DKK 73.6 million.

Currently, the municipality is establishing a community health centre which will comprise an intermediary unit and be the basis for an acute outgoing function. The health centre is expected to be completed in 2016.

As a result of the positive business case, the municipality has, however, chosen to expand their current 24-hour rehabilitation offer with 28 spaces, and as of August 2013, they were able to offer the municipality’s citizens faster rehabilitation after hospital admission, reduce the number of unnecessary admissions and ensure early detection and intervention with the purpose of ensuring the citizens’ level of function, quality of life and hence reduced care needs within the framework of the municipality.

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