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The European Journal of Health Economics

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Open Access 01-06-2019 | Original Paper

Co-ordination of health care: the case of hospital emergency admissions

Authors: M. Kamrul Islam, Egil Kjerstad

Published in: The European Journal of Health Economics | Issue 4/2019

Abstract

The recognition that chronic care delivery is suboptimal has led many health authorities around the world to redesign it. In Norway, the Department of Health and Care Services implemented the Coordination Reform in January 2012. One policy instrument was to build emergency bed capacity (EBC) as an integrated part of primary care service provided by municipalities. The explicit aim was to reduce the rate of avoidable admissions to state-owned hospitals. Using five different sources of register data and a quasi-experimental framework—the “difference-in-differences” regression approach—we estimated the association between changes in EBC on changes in aggregate emergency hospital admissions for eight ambulatory care sensitive conditions (ACSC). The results show that EBC is negatively associated with changes in aggregate ACSC emergency admissions. The associations are largely consistent with alternative model specifications. We also estimated the relationship between changes in EBC on changes in each ACSC condition separately. Our results are mixed. EBC is negatively associated with emergency hospital admissions for asthma, angina and chronic obstructive pulmonary disease but not congestive heart failure and diabetes. The main implication of the study is that EBC within primary care is potentially a sensible way of redesigning chronic care.

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Askildsen et al. [2] concluded that the use of specialist somatic health-care services has not changed as a result of the municipal co-payment system, using data from the same time period as here (2010–2013).

About USD 474 or EUR 434.

ACSC is customarily grouped in the categories of chronic, acute and vaccine-preventable (see, for example, Tian et al. [20]). See Purdy et al. [13] for a discussion of different definitions of ACSC and the associated disease codes.

We omitted 10 municipalities because of ambiguity regarding the timing of the implementation of EBC. These municipalities appear to have introduced EBC before the reform year (2012). See Fig. 1.

Model B1: reform × treat(\({\hat {\beta }_3}\)); model B2: reform1 × treat (\(\beta _{3}^{{{\text{B}}2}}\)); model S1: reform × treat₁(\(\beta _{3}^{{{\text{S}}1}}\)); model S2: reform₁ × treat₁(\(\beta _{3}^{{{\text{BS}}2}}\)).

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Title: Co-ordination of health care: the case of hospital emergency admissions
Authors: M. Kamrul Islam
Egil Kjerstad
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: The European Journal of Health Economics / Issue 4/2019
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-018-1015-x

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Co-ordination of health care: the case of hospital emergency admissions

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