Table 3 Structural recommendations... | Emerald Publishing

Table 3

Structural recommendations identified in the three case studies

Audit	Structural recommendations with transformative potential
Social benefits (EUR 978 million)	Define benefit objectives with targets and indicators enabling accountability and evidence-based decisions
	Integrate information systems enabling real-time cross-database verification and transparent data traceability
	Reduce provision complexity; eliminate separation between state pensions and guaranteed citizenship income
	Implement automated beneficiary verification and database integration preventing structural payment failures
Renal care (378,350 sessions)	Approve updated strategic plan renewing prevalence projections and care level definitions, update haemodialysis centre location criteria
	Estimate the cost of different dialysis services and update tariffs paid to various service providers
	Re-evaluate peritoneal and home haemodialysis tariffs to facilitate hospital provision of home-based techniques
	Extend maximum wait-time guarantees to vascular access interventions; accelerate arteriovenous fistula placement
Hospital service compensation (54.20% of care expenditure, excluding COVID-19 funding)	Establish uniform provider unit criteria: each unit must correspond to one acute hospital facility
	Promote modification whereby hospital discharge pricing is grounded in a case-complexity-centred payment model using case-mix weights estimated from actual costs, with necessary adjustments for centre structure factors
	Develop uniform analytical accounting framework for all regional hospital network acute hospitals to enable reliable estimations of actual regional hospital costs, replacing current US-based cost estimates for accurate case-mix weighting

Audit	Structural recommendations with transformative potential
Social benefits (EUR 978 million)	Define benefit objectives with targets and indicators enabling accountability and evidence-based decisions
	Integrate information systems enabling real-time cross-database verification and transparent data traceability
	Reduce provision complexity; eliminate separation between state pensions and guaranteed citizenship income
	Implement automated beneficiary verification and database integration preventing structural payment failures
Renal care (378,350 sessions)	Approve updated strategic plan renewing prevalence projections and care level definitions, update haemodialysis centre location criteria
	Estimate the cost of different dialysis services and update tariffs paid to various service providers
	Re-evaluate peritoneal and home haemodialysis tariffs to facilitate hospital provision of home-based techniques
	Extend maximum wait-time guarantees to vascular access interventions; accelerate arteriovenous fistula placement
Hospital service compensation (54.20% of care expenditure, excluding COVID-19 funding)	Establish uniform provider unit criteria: each unit must correspond to one acute hospital facility
	Promote modification whereby hospital discharge pricing is grounded in a case-complexity-centred payment model using case-mix weights estimated from actual costs, with necessary adjustments for centre structure factors
	Develop uniform analytical accounting framework for all regional hospital network acute hospitals to enable reliable estimations of actual regional hospital costs, replacing current US-based cost estimates for accurate case-mix weighting

Source(s): Authors’ elaboration based on operational audit reports from the Sindicatura de Comptes de Catalunya