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Presentation

Session: Caring for the Elderly
Room: Elissa Hall
Time: Sat 10:15-11:30

Presenter: Jun Yin (Akershus University Hospital. Health Services Research Group)

Abstract

Activity based financing (ABF) of hospitals give incentives to increase the number of patients treated, shortening the length of each hospital stay, and give, in most cases, no incentives to avoid re-admissions. For old frail patients early discharge increases the risk of a new hospitalisation in the immediate future. On the contrary, some extra days of hospitalisation may reduce the risk of a re-admission, make the patient more self-reliant and reduce the need for future formal care. Norms and quality standards may on the other side reduce and even remove the adverse incentive effects of ABF-systems. Hence, whether ABF actually imply that hospitals systematically split hospital stays and increase the number of readmissions is an empirical question that needs investigation.

To answer the question, number of hospital stays per patient and the number of readmissions are analyzed as response to changes in the activity based component of the financing system of Norwegian hospitals in the period from 1999 to 2008. Our main hypothesis is that an increase in the activity based component increase the number of hospital stays and re-admissions. However, we expect the effect of the activity based component to interact with other institutional variables as the hospitals financial situation, the level of fiscal decentralization within the hospital, the patients’ travel distance from home to hospital and characteristics of the resident municipality.

Data on the number of hospital stays per patient per hospital is available from the patient record from the Norwegian Patient Register. The data also consists of variables describing the individual patient’s length of stay, age, gender, diagnosis, DRG-weight and number of co-morbidities. These data are merged with data on hospital characteristics like staffing ratios and data on the hospitals’ financial system on the department level in each hospital. To control for characteristics with the resident municipality we include variables on the number of nursing home beds, the number of short stay nursing home beds, the number of home care receivers relative to the number of the population aged 80 and above, indicators of the centrality of the municipality and whether there is a hospital in the municipality. These data are extracted from Statistics Norway.

Data are analyzed by means of standard panel data techniques, including random and fixed effects models. Initial findings indicate that length of stay has been reduced and number of stays per patient has increased over time among patients 70 years and older suffering from ischemic heart diseases and stroke. In the final version of the paper results from the full models will be presented. We conclude by discussing potential conflicts between economic incentives designed to increase efficiency and health policy goal of efficient use of the total health care resources.

Key Terms

Hospital length of stay, activity based financing, elderly.

Authors:

Jun Yin (Akershus University Hospital. Health Services Research Group) , Hilde Luras (Akershus University Hospital. Health Services Research Group) and Terje P. Hagen (University of Oslo. Dep. of Health Economics and Health Management)

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