Hospital benchmarking

Quality description

The quality description of the Statistics of Health Expenditure and Financing assesses the reliability and suitability of the statistics for different purposes in accordance with the quality description recommendation of the Official Statistics of Finland (OSF).

Relevance of statistical data

The statistical report contains data on the use, costs and productivity of hospital activities broken down by hospital district, hospital, municipality and specialty. In addition, the data on hospital activities and finances (the Benchmarking data) contain data by NordDRG patient group.

The statistical report aims to provide information for comparison, guidance, evaluation, decision-making and planning concerning hospital activities.

The statistical report covers all hospital districts as well as six hospitals that used to be members in hospital districts. The data on Pohjois-Kymi Hospital (former Kuusankoski Regional Hospital) have not been included in the report, because the hospital, due to organisational changes, has not been able to provide its cost data since 2011.

The regional analysis covers even specialised inpatient care in private hospitals as well as nearly all day surgeries performed in the private sector. The private sector accounts for some 2% of all imputed costs. Services purchased by Pirkanmaa Hospital District from the Coxa Hospital for Joint Replacement and TAYS Heart Hospital are included in the costs of Tampere University Hospital (TAYS).

In the statistical report, the hospitals have been grouped into the following hospital types:

  • University hospitals
  • Central hospitals. The group of central hospitals even includes Hyvinkää Hospital, although it is not officially a central hospital. However, the scope of its activities is closer to central hospitals than the group of other hospitals.
  • Other hospitals include mostly regional hospitals and similar units. This group even includes hospitals that previously were members in hospital districts. These are: Forssa Hospital, Iisalmi Hospital, Pietarsaari Hospital, Pohjois-Kymi Hospital, Raahe Hospital, and Varkaus Hospital.
  • Specialist-led health centre hospitals. This group includes specialist-led hospitals operating as part of primary health care, with the exception of the specialist-led health centre hospitals that are included in the group of other hospitals.

As of 2006, the data on hospital activities and finances have included seven specialist-led health centre hospitals, and five more specialist-led health centre hospitals were included in the data as of 2007. The Benchmarking data include data on all hospital districts as well as all the specialist-led health centre hospitals that provide specialised somatic health services. The comparison of productivity in this hospital group does not include data from the specialist-led health centre hospital in Kuopio since the cost data reported are not comparable. Data are missing from Raahe Regional Hospital, previously a member of the Satakunta Hospital District.

Regarding both the cross-sectional analyses and the time-series analyses, the data on specialist-led health centre hospitals have been reported in the same way as for other types of hospitals, with the exception of the specialties of internal medicine and surgery. No analysis by specialty is carried out for specialist-led health centre hospitals because there are great variations in the specialist services provided by this type of hospitals. These data are, nevertheless, available in the electronic Benchmarking data.

Furthermore, the data on specialist-led health centre hospitals should be viewed with some reservation because the hospitals still need to improve the quality of data both in terms of Hilmo Care Register data and cost data. Moreover, there are fairly significant differences in the operation profiles of these hospitals, making comparisons difficult. The material is, however, a good starting point for improving the quality of data.

The statistical report does not cover specialised psychiatric care.

The data are based on the Hilmo Care Register data submitted by the hospitals. The data collection is based on the Act on the National Institute for Health and Welfare (668/2008), the Act on the National Statistical Service of STAKES (409/2001), on the Act on the National Personal Records Kept under the Health Care System (556/1989) and the subsequent Decree (1671/1993). The data have been supplemented with cost data provided by hospitals both at the level of specialty and the whole hospital.

The statistical report is based on the Hospital Benchmarking Data System developed by hospital districts and STAKES in 1997–2006. The report text explains key concepts and definitions.

Description of methods

Data on hospital activities and productivity are examined by patient group. Patient groups are based on the NordDRG Full system, where the outpatient visits and inpatient care periods of an individual patient are assigned to patient groups based on medical condition and use of hospital resources (clinical severity). The 2013 NordDRG Full grouper has been applied to all years in the time-series analyses as well as to the cross-sectional analysis on 2013.

Each NordDRG Full patient group is assigned a cost weight, which describes the relative need for resources in inpatient and outpatient care for the relevant patient group. The cost weights used are the 2013 NordDRG Full weights, calculated by THL. These have been amended to correspond with the patient structure (casemix) in the whole country in 2013. The calculation uses patient-specific cost data from the Hospital District of Helsinki and Uusimaa (HUS). The cost weights include even outlier costs for exceptionally expensive or cheap activities.

Two benchmarking methods have been used: the time-series analysis compares the productivity of a hospital in 2009–2013, and the cross-sectional analysis on 2013 compares the productivity of a hospital to other similar hospitals. The analysis can focus on either providers or regions. The region-specific analysis focuses on services used by the population in a specific region, hospital district or municipality as well as on the imputed costs of those services.

Intermediate outputs include care days, care periods and outpatient visits, while the final output is the episode, forming the foundation for measuring productivity. Outputs are calculated by weighting the number of different types of episodes with appropriate cost weights. The total output of a hospital or a specialty is the sum of all weighted episodes. The weights used include the total costs and the specialty-specific costs of hospitals.

Correctness and accuracy of data

Responsibility for data correctness rests with the data source. Preliminary output and cost data are collated at THL and compared with the previous year's data. The data are, then, submitted for inspection and approval by the hospitals. The 2013 Care Register data, grouped into DRG patient groups, are also submitted for inspection and approval.

The comparability of the data is affected by differing or insufficient practices of recording data on diagnoses and procedures in hospitals' own basic data systems as well as by the process of transferring data recorded in the basic data systems into the Care Register. Drug therapy data are not collected systematically into the Care Register.

The currently applied characteristics of the DRG grouper and the DRG cost weights do not necessarily take clinical severity sufficiently into account. The cost weights are calculated on the basis of patient-specific cost data of the HUS hospitals. More extensive access to patient-specific cost data would improve data reliability.

Timeliness and promptness of published data

´The statistical report covers the years from 2009 to 2013. It has been agreed with the hospital districts that the productivity review period is five years. To enable comparisons of service provision in different years, each year has been grouped using the NordDRG Full grouper for the last year under review. The statistical report is published every year. The publication of the statistics can be delayed due to insufficient or erroneous data submitted by hospitals that must be corrected or supplemented retrospectively.

Earlier statistical reports are available at: www.julkari.fi

The electronic databases (Benchmarking cubes) are updated with new data, and consequently previous cubes are not publicly available online.

Accessibility and transparency/clarity of data

The statistical report is published on THL’s website.

The data published in the statistical report are based on the data on hospital activities and finances (the Benchmarking cubes). The hospitals have had access to the first set of data since July 2014. The basic data have been corrected and supplemented in collaboration with the hospitals. The amended preliminary data were published for the hospitals' use in December 2014.

Comparability of statistical data

´The quality and reliability of the data included in the statistics has been improved continuously. However, there are still differences in the hospitals' data recording and cost accounting practices which may affect the final data. National development work to standardise the practices of data recording and cost accounting will improve the quality of health care data. Moreover, national and international work to develop the DRG system improves the quality of these data.

There may be some deficiencies in the comparability of data, especially with regard to specialist-led health centre hospitals. These hospitals have different kinds of profiles in terms of activities and specialties. The DRG method cannot necessarily cater for all these differences.

Moreover, in the group of other hospitals, there have been some structural changes which may affect the comparability of data.

Clarity and consistency

Productivity is measured as the relationship between the outputs and inputs of hospital activities. Outputs refer to care periods and outpatient visits (NordDRG Full care periods), while final outputs are expressed with the concept of episode, which was developed in collaboration with the hospital districts. Hospitals' patient structures have a significant impact on the comparability of data, and therefore NordDRG Full grouping and weights are used to ensure that differences in patient structures are taken into account in the output data. The NordDRG classification is in common use in the Nordic countries and Finland. Its grouping rules are available online.

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