How well coordinated are patient hospital careers? Evidence from Saxony, Germany

Abstract

This study focuses on the question of to what extent patient hospital careers take place in a coordinated way. So, nearly 60,000 hospitalizations with a diagnosis within the same diagnosis spectrum were analysed. The hospitalizations took place in a large regional area within Saxony, Germany. The patient catchment areas were hierarchically ordered (rural/urban) so that a representative sample of all hospitals was obtained. We conclude that in general there is a high degree of intrasectoral coordination in the acute inpatient sector. This applies especially for regions that are near a hospital of a higher care level. Observable problems in the process reflect a weak structure of outpatient care, problems related to rural areas, strategic incentives to pass on cost-intensive cases, or existing informal networks.