Cost component

Cost unit and method of calculation

Inpatient and outpatient services delivered in Danish hospitals registered in DNPaR

Diagnosis Related Grouping system tariffs, year 2012 [30] .The DRG tariff system is developed for administrative purposeand based on rough average costs across hospitals for specific diagnostic groups. Excludes interest and depreciation of buildings and equipment while other overhead costs are included.

Primary care services delivered by general practitioners andprivately practicing specialists such as: dentists, physiotherapists, chiropractors and chiropodists who are registered in DNHSR

Reimbursement fees between the National Health Insurance scheme and private practicing physicians are used as cost units. General practitioners are compensated by regions through a combination of per capita fee (app.30% of total) and fee for service (app. 70%) [31] . To reflect this payment scheme in the unit cost, 43.8% of the fee for service in general practice was added on top. Overhead costs covered by capitation fee were, hence not distributed across numbers of visits, as would have been most appropriate, but by resource burden.

Prescribed pharmaceuticals dispensed by Danish pharmacies and registered in DNPrR (Pharmaceuticals consumed in hospitals are included in DRG-tariffs. Over-the-counter drugs are not included in the statements)

Total Sales Price (TSP) includes patient Out of Pocket Payments (OPP), since costs of prescribed pharmaceuticals are shared between the patient and the primary health care sector by a copayment scheme, where patients are reimbursed according to their need. These costs were aggregated, since total costs are measured regardless of who pays. While pharmaceutical consumption includes value added tax (VAT), Danish health care services are exempted from VAT. Given that VAT is 25% in Denmark, 20% of pharmaceutical consumption was subtracted to get comparable net costs.

Costs of living in a nursing home/sheltered accommodation

Based on individually registered address in SD

Unit cost was calculated as total annual costs of running these facilities divided by the number of inhabitants, 51,486 DKK (exclusive of capital costs) per person living in nursing homes per year. Hereto was added average number of hours of nursing received by persons living at nursing homes or sheltered accommodation calculated by SD equal to 18.6 hours per week per person or 565,283 DKK applying a unit cost of 588 DKK per hour. In total 616,769 DKK per person per year. The cost unit included overhead and administration but not capital costs.

Referred monthly personal nursing and practical care in own home per year based on individual registrations in SD

Registrations on volume of services were, incomplete whereas whereas number of individuals receiving care appeared rather completely registered. Therefore, national volume estimates from SD were applied together with the number of PwD receiving care compared to the expected number given the observed frequency among the diabetes-free population, in gender and age strata, to estimate the amount of nursing services received attributable to diabetes. Average number of hours of nursing received by persons living in their own home was estimated to be 3.6 hours. The unit cost was defined as average costs for one hour of nursing delivered in the given year (calculated as the total costs for nursing divided by number of hours of care delivered in the year),based on data published by SD, equal to 588 DKK per hour.

Home nurse visits per year based on individual registrations in SD

Number of visits by home nurse appeared rather completely registered on an individual basis. Unit cost was calculated as average costs for home nurses per inhabitant times the Danish population divided by the total number of services,based on data published by SD.One service is estimated to be 456 DKK.