Economic incentives and survival probabilities for chronic and multimorbidity patients - Do the relationships depend on patient pathways?

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> The Norwegian Coordination Reform (CR) in 2012 introduced new economic incentives aimed at weaknesses in interaction between primary care, social care and specialist care. This paper studies the association of a new co-payment scheme on the 30-day and 90-day survival probabilities for chronic and multimorbidity patients. We also analyse whether admission types ⸺ planned or emergency ⸺ matters for survival rates, and the importance of patient pathways. Several different pathways are possible, depending on where patients came from before being admitted to hospital and their destination after discharge from hospital. <jats:bold> </jats:bold><jats:bold>Methods:</jats:bold> The study uses data from three different registers for the period 2010 to 2013. We consider 30 common chronic conditions for which administrative data are available (n=563,096 in-patient episodes). We look at three mutually exclusive pathways. They are relevant and important in terms of the number of patients depending on co-operation and co-ordination between health care providers. Using a quasi-experimental design—the difference-in-differences approach—we estimate the associations between the co-payment scheme and survival probability by admission type and by patient pathway. <jats:bold>Results:</jats:bold> We find that the change in survival probabilities are significant and positively associated with the co-payment scheme for emergency admissions, but no significant association is found for planned admissions for the 30-day survival. A positive and significant relationship is also found for emergency patients for two specific pathways. For planned admissions, the survival probabilities are significantly and negatively associated for patients coming from home and later discharged to social care institutions. Multimorbidity subgroup analysis shows that the positive (negative) association with the 90-day (30-day) survival is significant only for emergency (planned) admissions for the patients coming from home and later discharged to home or social care after in-patient hospitalization. <jats:bold> </jats:bold><jats:bold>Conclusion:</jats:bold> We conclude that the survival probabilities are positively associated with the new economic incentives but the result depends on admission type, patient pathway and multimorbidity status. Without modelling admission type, pathway and multimorbidity explicitly, one may overlook important relationships associated with the economic incentives. Future policy evaluations in any pertinent context should envisage these aspects.</jats:p>