Avoiding admissions : the most cost effective delivery of acute care to residents of aged-care facilities in the Hutt Valley : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Business Studies in Management at Massey University
The highest annual costs of health care occur in the last one to two years of life. The most expensive part of health care provision during this period is aged-residential care. As residents of aged-care facilities are frail and suffer from chronic illness, periodic medical care is required. For residents of aged-care facilities in the Hutt Valley, this medical intervention is either provided on-site with the assistance of the contract general practitioner or the resident is acutely admitted to the Hutt Hospital. Such admissions incur a significant cost to the District Health Board, which continues to pay for the aged-residential care bed for up to 21 days in any one calendar year even if a bed is vacated for an acute hospitalisation. This study examined acute admission data of aged-care facility residents admitted into Hutt Hospital during 2003 from 1 Dec 2002 to 30 November 2003. This was compared (the acute admission data) to a census of 18 aged-care facilities in the Hutt Valley to identify the most cost effective delivery of acute care to the residents. Analysis of data collected from the study supported a number of variables that impact on acute admission rates. These variables included attitude of the aged-care facility manager to acute admission, access to registered nursing, facility characteristics and contractual arrangements with general practitioners. Five alternative models of acute care delivery were examined for possible impact on acute admission rates and cost effectiveness. The most cost effective delivery of acute care to residents of aged-care delivery is through a twenty-four hour contractual arrangement with a general practitioner. However, variables such as contractual obligations of aged-care facilities, profit status, staffing configuration and whether a facility also offers other retirement options such as villas impact on acute admission rates and have implications in the development of older persons policy in New Zealand. Health researchers in New Zealand have not explored this area to date. Given the cost to the economy and the future fiscal risk with the increasing number of older people, this is an area that requires urgent research attention.