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Hospital coordination and integration with social care in England: The effect on post-operative length of stay


  • Fernandez, Jose-Luis
  • McGuire, Alistair
  • Raikou, Maria


In spite of significant policy interest in improving the integration of health and social care services, little is known about the economics of coordination across the two sectors. We specify a Markov queuing model and use data collected from administrative records to estimate the link between two proxy indicators of across-sector complexity of discharge arrangements and post-operative length of stay in hospital for older people undergoing hip replacements. The results suggest that the number of local authorities involved in care planning and commissioning of social care services for discharges from a given hospital is significantly positively correlated with longer post-operative lengths of stay. A particularly strong effect is found between variability through time in the number of authorities involved in discharges from a given hospital and lengths of stay. The results suggest that improving information systems and joint assessment processes used during the discharge of patients with social care needs is likely to achieve significant efficiency gains in the health care system as a whole.

Suggested Citation

  • Fernandez, Jose-Luis & McGuire, Alistair & Raikou, Maria, 2018. "Hospital coordination and integration with social care in England: The effect on post-operative length of stay," Journal of Health Economics, Elsevier, vol. 61(C), pages 233-243.
  • Handle: RePEc:eee:jhecon:v:61:y:2018:i:c:p:233-243
    DOI: 10.1016/j.jhealeco.2018.02.005

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    References listed on IDEAS

    1. Siciliani Luigi, 2013. "The Economics of Long-Term Care," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 14(2), pages 343-375, August.
    2. Jose-Luis Fernandez & J. Forder, 2008. "Consequences of local variations in social care on the performance of the acute health care sector," Applied Economics, Taylor & Francis Journals, vol. 40(12), pages 1503-1518.
    3. Gabriel Picone & R. Mark Wilson & Shin-Yi Chou, 2003. "Analysis of hospital length of stay and discharge destination using hazard functions with unmeasured heterogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 12(12), pages 1021-1034.
    4. Julien Forder, 2009. "Long-term care and hospital utilisation by older people: an analysis of substitution rates," Health Economics, John Wiley & Sons, Ltd., vol. 18(11), pages 1322-1338.
    5. James Gaughan & Hugh Gravelle & Luigi Siciliani, 2015. "Testing the Bed‐Blocking Hypothesis: Does Nursing and Care Home Supply Reduce Delayed Hospital Discharges?," Health Economics, John Wiley & Sons, Ltd., vol. 24, pages 32-44, March.
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    Cited by:

    1. Walsh, Brendan & Wren, Maev-Ann & Smith, Samantha & Lyons, Seán & Eighan, James & Morgenroth, Edgar, 2019. "An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital," Research Series, Economic and Social Research Institute (ESRI), number RS91.

    More about this item


    Integration; Delayed discharge; Coordination; Length of stay; Survival; Social care;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C41 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods: Special Topics - - - Duration Analysis; Optimal Timing Strategies


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