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Merjenje učinkovitosti nabav zdravil
VIRŠČEK, ANDREJ (Author), Sambt, Jože (Mentor) More about this mentor... This link opens in a new window

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Abstract
Zdravila za bolnišnično uporabo predstavljajo naraščajoč zdravstveni izdatek v Sloveniji in svetu. Namen magistrskega dela je nadgraditi obstoječi analitični pristop pri ocenjevanju uspešnosti nakupov zdravil v bolnišnicah in širše v scenarijih, kjer več subjektov kupuje istovrstne izdelke. Temeljni problem pri ocenjevanju učinkovitosti nabave je upoštevanje nakupne količine pri primerjavi vrednosti nabave, kar je pogoj za nepristransko primerjavo deležnikov, ki kupujejo različne količine istovrstnega izdelka, saj je cena izdelka odvisna od količinskega obsega nabave. Drugi problem predstavlja agregiranje metrike učinkovitosti posameznih odločevalskih enot (v nadaljevanju OE) v sklopu večih kategorij. To bi omogočalo relativno primerjavo učinkovitosti nakupov med odločevalskimi enotami pri izbranem naboru kategorij. Tretji problem se nanaša na razvoj metrike, ki bi merila vrednost preplačila v posamezni kategoriji ali sklopu kategorij in s tem podala informacijo o potencialu za izboljšanje procesov nabave. Obstoječe empirične rešitve za temeljni problem izločanja vpliva količine v literaturi slonijo na regresijski analizi (glej Tanner, 2014 in Balut et al., 1991). Ta modelira povprečno vrednost pri dani količini, medtem ko za izračun učinkovitosti potrebujemo informacijo o najnižji doseženi vrednosti. Za ta namen je bilo treba standardno regresijsko analizo ustrezno prilagoditi. Prilagojene regresijske metode in izbrano metodo ovojnice podatkov sem nato preizkusil v simulacijski študiji, kjer sem preveril njihovo učinkovitost -- kako dobro identificirajo neučinkovitost OE v kategoriji in pristranskost -- kako se učinkovitost metode spreminja glede na količinski rang OE v kategoriji. Le razmeroma nepristranska metoda namreč lahko služi za primerjavo učinkovitosti OE. Nato sem razvil lastno metodo agregiranja učinkovitosti, poimenovano kvantilna metoda. Ta rešuje problem relativnega razvrščanja odločevalskih enot v sklopu več kategorij, pri čemer upošteva težavnost doseganja učinkovitosti v posamezni kategoriji. Iz kvantilne metode sem izpeljal metodo referenčnega prihranka. Ta meri prihranek v kategoriji ali sklopu kategorij in za posamezno OE ali sklop OE, pod pogojem doseganja enake kvantilne učinkovitosti kot izbrana referenčna OE. Simulacijske študije so pokazale, da učinkovitost metod za merjenje učinkovitosti strmo raste s številom enot v kategoriji, medtem ko pristranskost pri izbrani metodi merjenja učinkovitosti s številom enot le nekoliko upada. Kljub obsežnemu naboru metod za merjenje učinkovitosti se je tudi najbolj učinkovita in najmanj pristranska izkazala za nedopustno pristransko pri izločanju vpliva količine nabave na vrednost izdelka v spodnjih ter zgornjih količinskih rangih. Ta lastnost uvaja v analizo podatkov omejitve, ki zmanjšujejo moč in povečujejo kompleksnost analize. Omejitve se prenesejo tudi na razvrščanje s kvantilno metodo agregiranja in na metodo referenčnega prihranka. Moja metodološka spoznanja torej omogočajo izločanje vplivov količine iz primerjave vrednosti, vendar za ceno večje kompleksnosti izvedbe analize. Kvantilna metoda je uporabna za nepristransko identifikacijo referenčne bolnišnice, na podlagi katere lahko izračunamo potencialne prihranke ostalih OE z metodo referenčnega prihranka. Podatek o referenčnem prihranku daje primerjanim bolnišnicam realistično informacijo o potencialu za optimizacijo nabavnega procesa.

Language:Slovenian
Keywords:nabava zdravil v bolnišnicah, primerjava metod merjenja učinkovitosti nabave homogenih izdelkov, metrike agregatne učinkovitosti, kvantilna metoda agregiranja, metoda referenčnega prihranka
Work type:Master's thesis/paper (mb22)
Organization:FE - Faculty of Electrical Engineering
Year:2018
Views:1993
Downloads:934
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Secondary language

Language:English
Abstract:
Pharmaceuticals for hospital use are a large and growing expense in national health budget in Slovenia and around the world. Procurement departments in hospitals and Ministry of health are responsible for controlling these costs. The goal of this thesis is to improve analytical approaches in estimating efficiency of procurement of pharmaceuticals. Approaches developed are generally applicable in scenarios where multiple subjects buy homogeneous products. Since product cost generally depends on purchase quantity, main challenge with estimating purchasing efficiency lies in controlling for quantity when comparing purchase value. This is necessary to assure unbiased comparison of stakeholders who buy different quantities of homogeneous product. Second challenge lies in aggregating efficiencies of stakeholders across many categories of products in order to rank them. Third challenge is to develop a measure to realistically assess value of overpay in single or multiple categories of products to provide an information about the feasible scope of improvement in procurement process. Existing empirical solutions for controlling for quantity are based on classical regression (see Tanner, 2014 in Balut et al., 1991). Regression models average value at given quantity. But to calculate efficiency we need to model the lowest attainable value. In order to identify the best method for that I designed a simulation study to test a range of specifically modified regression methods and a type of data envelopment method. Furthermore I developed an unique method of aggregating efficiency named quantile method. This method ranks decision making units (or DMU) based on difficulty of attaining efficiency in analysed categories. We also developed a method to realistically measure savings potential called a method of referential savings. This method measures potentially attainable savings conditioned on reaching the same quantile efficiency than selected referential DMU. Even the best method for measuring efficiency has been found to be excessively biased in upper and lower quantity ranks. This introduces limitations in data analysis and also reduces power and increases complexity of the process. This limitation also affects quantile method and method of referential savings. Quantile method is used to identify referential hospital which can be used to calculate potential savings of other DMU with the method of referential savings. Data about referential savings gives hospitals easily interpretable information about optimization potential of procurement process.

Keywords:pharmaceutical procurement in hospitals, comparison of methods for measuring buying efficiency of homogenous products, measurements of aggregate efficiency, quantile aggregation method, method of referential savings

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