Thomas Renaud

Bio: Thomas Renaud is an academic researcher from EHESP. The author has contributed to research in topics: Medicine & Internal medicine. The author has an hindex of 8, co-authored 22 publications receiving 257 citations.

How well do diagnosis-related groups explain variations in costs or length of stay among patients and across hospitals? Methods for analysing routine patient data

Abstract: We set out an analytical strategy to examine variations in resource use, whether cost or length of stay, of patients hospitalised with different conditions. The methods are designed to evaluate (i) how well diagnosis-related groups (DRGs) capture variation in resource use relative to other patient characteristics and (ii) what influence the hospital has on their resource use. In a first step, we examine the influence of variables that describe each individual patient, including the DRG to which the patients are assigned and a range of personal and treatment-related characteristics. In a second step, we explore the influence that hospitals have on the average cost or length of stay of their patients, purged of the influence of the variables accounted for in the first stage. We provide a rationale for the variables used in both stages of the analysis and detail how each is defined. The analytical strategy allows us (i) to identify those factors that explain variation in resource use across patients, (ii) to assess the explanatory power of DRGs relative to other patient and treatment characteristics and (iii) to assess relative hospital performance in managing resources and the characteristics of hospitals that explain this performance.

Variabilité des pratiques médicales en médecine générale : la prescription d'antibiotiques dons la rhinopharyngite aiguë

Abstract: Les antibiotiques sont parmi les medicaments les plus prescrits et les plus consommes en France. Ils sont souvent d'un usage inopproprie - notamment pour infection aigue des voies aeriennes superieures - et, de ce fait, problematiques en termes de sante publique (resistance bacterienne) et de maitrise des depenses de sante. A partir des donnees d'activite d'un panel de generalistes francais en 2001, nous montrons qu'une consultation sur deux pour rhinopharyngite aigue donne lieu a un traitement par antibiotherapie. Dans la plupart des cas, les caracteristiques cliniques des patients determinent le recours a l'antibiotherapie mais ne suffisent pas a le justifier, selon les recommandations de pratiques medicales elaborees notamment par l'AFSSAPS. Au-dela des differences relevees entre les patients - par exemple, les actifs et les hommes sont plus souvent traites par antibiotiques - le recours a l'antibiotherapie est heterogene chez les generalistes. Certaines de leurs caracteristiques professionnelles et demographiques expliquent en partie cette heterogeneite. La participation a un reseau de soins et la formation medicale continue favorisent une moindre prescription d'antibiotiques. A contrario, le nombre de visiteurs medicaux recus par le generaliste est associe a une plus forte prescription d'antibiotiques

Les dépenses de prévention et les dépenses de soins par pathologie en France

Abstract: Realisee a partir des comptes nationaux de la sante de 2002, cette etude presente une estimation de la repartition des depenses de sante d'une part entre soins curatifs et soins preventifs et, d'autre part, entre les grands groupes de pathologies. En 2002, la France a consacre 10,5 milliards d'euros a la prevention, soit 6,4% de la depense courante de sante, la moitie etant destinee a eviter la survenue d'une maladie ou d'un etat indesirable, le quart au depistage des maladies et un autre quart a la prise en charge des facteurs de risque ou des formes precoces des maladies. Les depenses de prevention issues de la consommation de soins et de biens medicaux s'elevent a 5,7 milliards d'euros. La consommation de soins et de biens medicaux qui ne ressort pas de la prevention a pu etre repartie par pathologie. Ainsi, les maladies cardiovasculaires representent le poste le plus important (12,6%), devant les troubles mentaux et les maladies osteo-articulaires (respectivement 10,6 % et 9 %). Les affections de la bouche et des dents predominent dans les depenses de soins ambulatoires (28,3 %) et les maladies circulatoires et les troubles mentaux concentrent a eux deux plus du quart des depenses hospitalieres.

How well do diagnosis-related groups for appendectomy explain variations in resource use? An analysis of patient-level data from 10 European countries.

Abstract: Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106 929 appendectomy patients treated in 939 hospitals in 10 European countries. In stage 1, we tested the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length of stay (three countries). The first model used only the diagnosis-related groups (DRGs) to which patients were coded, the second model used a core set of general patient-level and appendectomy-specific variables, and the third model combined both sets of variables. In stage two, we investigated hospital-level variation. In classifying appendectomy patients, most DRG systems take account of complex diagnoses and comorbidities but use different numbers of DRGs (range: 2 to 8). The capacity of DRGs and patient-level variables to explain patient-level cost variation ranges from 34% in Spain to over 60% in England and France. All DRG systems can make better use of administrative data such as the patient's age, diagnoses and procedures, and all countries have outlying hospitals that could improve their management of resources for appendectomy. Copyright © 2012 John Wiley & Sons, Ltd.

Economic burden of cardiovascular diseases in the enlarged European Union.

Abstract: Aims Cardiovascular disease (CVD), together with its main components, coronary heart disease (CHD), and cerebrovascular diseases, is the main source of morbidity and mortality in the European Union (EU), but to date, there has not been any systematic cost-of-illness study to assess the economic impact of CVD in the EU. Methods and results CVD-related expenditure was estimated using aggregate data on morbidity, mortality, and healthcare resource use. Healthcare costs were estimated from expenditure on primary, outpatient, emergency, and inpatient care, as well as medications. Costs of unpaid care and lost earnings due to morbidity and premature death were included in the study. CVD was estimated to cost the EU €169 billion annually, with healthcare accounting for 62% of costs. Productivity losses and informal care represented 21% and 17% of costs, respectively. CHD represented 27% and cerebrovascular diseases 20% of overall CVD costs. Conclusion CVD is a leading public health problem. Our study is the first to assess the economic burden of CVD across the EU, and our results should help policy makers evaluate policy impact and prioritize research expenditures. However, because of data unavailability, our study has important limitations, which highlight the need for more accurate and comparable CVD-specific information.

Causes and Consequences of Regional Variations in Health Care

Abstract: There are widespread differences in health care spending and utilization across regions of the US as well as in other countries. Are these variations caused by demand-side factors such as patient preferences, health status, income, or access? Or are they caused by supply-side factors such as provider financial incentives, beliefs, ability, or practice norms? In this chapter, I first consider regional health care differences in the context of a simple demand and supply model, and then focus on the empirical evidence documenting causes of variations. While demand factors are important—health in particular—there remains strong evidence for supply-driven differences in utilization. I then consider evidence on the causal impact of spending on outcomes, and conclude that it is less important how much money is spent, and far more important how the money is spent—whether for highly effective treatments such as beta blockers or anti-retroviral treatments for AIDS patients, or ineffective treatments such as feeding tubes for advanced dementia patients.

Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland

Abstract: This paper investigates the determinants of regional variations in outpatient antibiotic consumption using Swiss data. The analysis contributes to the debate on appropriate antibiotic use by improving the understanding of its determinants, and may help to define more effective health care policies to reduce the resistance phenomenon. Findings suggest that Switzerland exhibits relatively low levels of consumption among European countries. There are significant differences between cantons both in the per capita antibiotic sales and defined daily doses per 1000 inhabitants (DID). Econometric estimations suggest that DID are significantly related to per capita income, antibiotic price, the density of medical practices, demographic, cultural and educational factors. The incidence of bacterial infections is also relevant. Appropriate policies affecting antibiotic consumption in the community can be designed by looking at crucial determinants in the model and their related impact.

Health Status Determinants: Lifestyle, Environment, Health Care Resources and Efficiency

Abstract: This paper aims to shed light on the contribution of health care and other determinants to the health status of the population and to provide evidence on whether or not health care resources are producing similar value for money across OECD countries. First, it discusses the pros and cons of various indicators of the health status, concluding that mortality and longevity indicators have some drawbacks but remain the best available proxies. Second, it suggests that changes in health care spending, lifestyle factors (smoking and alcohol consumption as well as diet), education, pollution and income have been important factors behind improvements in health status. Third, it derives estimates of countries’ relative performance in transforming health care resources into longevity from two different methods – panel data regressions and data envelopment analysis – which give remarkably consistent results. The empirical estimates suggest that potential efficiency gains might be large enough to raise life expectancy at birth by almost three years on average for OECD countries, while a 10% increase in total health spending would increase life expectancy by three to four months.