Health as a mathematical model - Strategic management in AIDS prevention and hospital funding

Vienna (FWF) - Having developed into a severe financial problem in many countries, AIDS has long ceased to be a purely emotional issue. Financial resources are channelled into preventive measures and into the treatment of AIDS patients with the aim of achieving maximum efficiency at minimum cost. Marion Rauner from the Department of Business Studies at the University of Vienna, sponsored by the Austrian Science Fund (FWF), has developed mathematical models which show and evaluate the effects of different measures and thus provide an important basis for future strategic decisions. Her models also reveal interesting aspects concerning the activity-based hospital funding scheme introduced in Austria in 1997.

The continuously rising cost of public health systems has resulted in a more targeted use of financial resources in many countries. Methods of strategic management are thus also gaining increasing importance in health care. Mathematical modelling plays an important role in this respect. It provides decision-makers with simulations that clearly demonstrate and evaluate the effects of their decisions. Marion Rauner has proved this point for two thematic areas, which earned her a promotional award from the City of Vienna. "We analysed and evaluated the measures launched for AIDS prevention and treatment in different target groups - homosexuals, prostitutes, drug addicts, heterosexuals etc. - and provided the institutions active in this area, i.e. the Red Cross, the Austrian AIDS Organisation, the Federal Ministry etc., with suggestions for future measures", explains Rauner. She demonstrated, for instance, that the Red Cross is well advised to continue its present policy of not admitting certain risk groups as blood donors, since the level of HIV infections in these groups is still very high. "We also proved that the needle exchange programme is very successful and effective with regard to AIDS in the field of drug addicts, but the virus continues to be transmitted by sexual behaviour. The increased distribution of condoms can be a simple and effective remedy", says Rauner.

Combined hospital funding recommended
In the second part of the research project Rauner took a closer look at the Austrian activity-based funding system of Austrian hospitals (LKF) and compared it to the global budget system used in Canada. "LKF is based on the remuneration of individual flat rates per case with a limited total budget. This has the advantage of shorter hospitalisation, better documentation and a targeted use of resources, but the flat rates per case may have the effect that hospitals shift their focus in documentation from cheaper to more expensive patient groups, that they tend to longer or more frequent treatments in intensive care units, or even discharge patients simply to re-admit them immediately afterwards", says Rauner, who succeeded in bringing the annual meeting of the "European Working Group on Operational Research Applied to Health Services" to Vienna for the first time. "The comparison with Canada shows that it would be more sensible to combine the two systems, i.e. fixed cost should be covered by a global budget, while the variable cost should be remunerated on the basis of flat rates per case."


Dr. Marion Rauner
Department of Business Studies, University of Vienna
T +43 1 42 77-38150

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