Understanding variations in hospital length of stay and cost

Lorenzoni, Luca; Marinò, Alberto

doi:10.1787/ae3a5ce9-en

Cited by 5 publications

(15 citation statements)

References 18 publications

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“…For instance, similar to our results, Gobillon and Milcent have found that differential use of surgical procedures contributed to the substantial regional disparity in AMI mortality in France [14]. In a multi-country analysis, Lorenzini and Marino have found that hospital size and types explain the cross-country variation in efficiency outcomes such as LOS and costs [16]. These studies highlighted the importance of understanding the disparity in healthcare delivery at different geographic levels.…”

Section: Discussionsupporting

confidence: 88%

“…Furthermore, our analysis of the geographic disparity of readmission rate is comparable to the research on the variation of hospital performance indicators such as emergency admission mortality [14,65], LOS [16] and hospital resource utilisation [17] in other contexts. For instance, similar to our results, Gobillon and Milcent have found that differential use of surgical procedures contributed to the substantial regional disparity in AMI mortality in France [14].…”

Section: Discussionsupporting

confidence: 58%

“…Inter-regional disparities in resource allocation and efficiency of care are generally considered to be one of the main drivers of variation in the different dimensions of healthcare [38]. Some recent researches have looked at the variation in health and wellbeing indicators [39][40][41]; others have quantified the inter-regional variation in healthcare delivery and hospital performances [14][15][16][17][18]. The findings stress the importance of both patient and hospital factors variations in explaining the geographic difference in healthrelated outcomes.…”

Section: Related Literaturementioning

confidence: 99%

“…However, the responsibility endowed at the sub-nation level and the quasi-market mechanism can potentially generate undesirable regional disparities in healthcare quality. As a result, an increasing body of literature has investigated the geographic variation in healthcare reimbursement and utilisation [13], hospital performance [14][15][16], and various other health outcome indicators [17,18].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy

2020

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Unwarranted variation in the quality of care challenges the sustainability of healthcare systems. Especially in decentralised healthcare systems, it is crucial to understand the drivers behind regional differences in hospital qualities such as unplanned readmissions. This paper examines the factors that influence the risk of unplanned hospital readmission and the geographic disparity of readmission rate in Italy. We use hospital discharge data from 2010 to 2015 for patients above 65 years old admitted with Acute Myocardial Infarction. Employing hierarchical models, we identified the patient and hospital-level determinants for unplanned readmission. In line with the literature, the risk of readmission increases with age and being male, while hospitals with higher patient volume and capacity tend to have lower unplanned readmission. In particular, we find that after patient risk-adjustments, there are differential effects of hospitalisation length-of-stay on the probability of readmission across the hospitals that are governed by different payment systems. For hospitals under a prospective payment system, the effect of length-of-stay in reducing the probability of readmission is weaker than hospitals under an ex-post global budget, but the overall readmission rates are the lowest. Moreover, there are substantial geographic variations in readmission rate across Local Health Authority and regions, and these variations of unplanned readmission are explained by differences in hospital length-of-stay and surgical procedures used. Our results demonstrate that differential hospital behaviours can be one of the potential mechanisms that drive geographic quality disparities.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 58%

Section: Related Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy

2020

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“…This paper reports initial findings of empirical analysis aimed at exploring the relationship between the degree of administrative decentralisation across levels of government in health care decision-making and health care spending, life expectancy and hospital costs. This empirical analysis builds on previous analytical research carried out by the OECD Secretariat on "Which policies increase value for money in health care" (Lorenzoni et al, 2018) and on "Understanding variations in hospital length of stay and cost" (Lorenzoni and Marino, 2017), both of which established new methodological tools to analyse health sector performance. The present analysis expands on this earlier work by adding "decentralisation" as a core explanatory variable in the country-level and hospitallevel models, at the request of the Fiscal Network and Joint Network of Senior Budget and Health Officials.…”

Section: Introduction and Main Findingsmentioning

confidence: 99%

The impact of decentralisation on the performance of health care systems

2019

OECD Working Papers on Fiscal Federalism

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FISCAL FEDERALISM WORKING PAPER SERIES This series is designed to make available to a wider readership selected studies drawing on the work of the OECD's Network on Fiscal Relations across Levels of Government. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language (English or French) with a short summary available in the other. OECD Working Papers should not be reported as representing the official views of the OECD or of its member countries. The opinions expressed and arguments employed are those of the author(s). Working Papers describe preliminary results or research in progress by the author(s) and are published to stimulate discussion on a broad range of issues on which the OECD works.

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Associations of acute medical care with the transfer and acceptance functions of hospitals in a region in Japan with limited medical resources

2023

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Background Japan’s health care system may be providing inpatient care inefficiently with a low number of physicians per hospital bed and a long average length of stay (LOS). The present study examined associations of acute medical care with hospital-level factors, such as the transfer and acceptance rates, and mediation effect of LOS, using medical service fees per day as an outcome measure for the provision of acute medical care in hospitals in a region with limited medical resources. Methods To analyze the associations of acute medical care with hospital-level factors, this research used multilevel structural equation modeling (SEM) of a dataset that included 225,203 patients admitted to 99 hospitals in Fukushima, Japan. The characteristics of the patients, medical activities, and hospitals, such as the transfer and acceptance rates, were assumed to have both direct and indirect effects through LOS on medical service fees per day. Results The final analysis used data from 165,413 patients discharged or transferred from 79 hospitals. After separating patient-level effects using multilevel SEM, the results revealed that, at the hospital level, the transfer rate had a significant and positive association with increased medical service fees per day, both directly (standardized coefficient [SC] = 0.215) and indirectly (SC = 0.057) through shortened LOS. The number of first hospitalized patients per physician had a significant and positive association with increased medical service fees per day only indirectly through shortened LOS (SC = 0.063). The acceptance rate had a significant and negative association with medical service fees per day only indirectly through prolonged LOS (SC = -0.078). Conclusions Hospital-level factors, such as enhanced transfer function, reduced acceptance function, and a large number of patients for treatment of acute episodes per physician, had positive associations with increased medical service fees per day, either directly or indirectly through LOS.

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Understanding variations in hospital length of stay and cost

Cited by 5 publications

References 18 publications

Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy

Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy

The impact of decentralisation on the performance of health care systems

Associations of acute medical care with the transfer and acceptance functions of hospitals in a region in Japan with limited medical resources

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