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Inefficiencies in a healthcare system with a regulatory split of power: a spatial panel data analysis of avoidable hospitalisations in Austria

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  • Anna-Theresa Renner

    (Vienna University of Economics and Business (WU))

Abstract

Despite generous universal social health insurance with little formal restrictions of outpatient utilisation, Austria exhibits high rates of avoidable hospitalisations, which indicate the inefficient provision of primary healthcare and might be a consequence of the strict regulatory split between the Austrian inpatient and outpatient sector. This paper exploits the considerable regional variations in acute and chronic avoidable hospitalisations in Austria to investigate whether those inefficiencies in primary care are rather related to regional healthcare supply or to population characteristics. To explicitly account for inter-regional dependencies, spatial panel data methods are applied to a comprehensive administrative dataset of all hospitalisations from 2008 to 2013 in the 117 Austrian districts. The initial selection of relevant covariates is based on Bayesian model averaging. The results of the analysis show that supply-side variables, such as the number of general practitioners, are significantly associated with decreased chronic and acute avoidable hospitalisations, whereas characteristics of the regional population, such as the share of population with university education or long-term unemployed, are less relevant. Furthermore, the spatial error term indicates that there are significant spatial dependencies between unobserved characteristics, such as practice style or patients’ utilization behaviour. Not accounting for those would result in omitted variable bias.

Suggested Citation

  • Anna-Theresa Renner, 2020. "Inefficiencies in a healthcare system with a regulatory split of power: a spatial panel data analysis of avoidable hospitalisations in Austria," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 85-104, February.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:1:d:10.1007_s10198-019-01113-7
    DOI: 10.1007/s10198-019-01113-7
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    References listed on IDEAS

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    1. Engelbert Theurl, 2015. "Reform of hospital financing in Austria: successes, failures, and the way forward," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 229-234, April.
    2. Reeves, Aaron & McKee, Martin & Basu, Sanjay & Stuckler, David, 2014. "The political economy of austerity and healthcare: Cross-national analysis of expenditure changes in 27 European nations 1995–2011," Health Policy, Elsevier, vol. 115(1), pages 1-8.
    3. William Whittaker & Laura Anselmi & Søren Rud Kristensen & Yiu-Shing Lau & Simon Bailey & Peter Bower & Katherine Checkland & Rebecca Elvey & Katy Rothwell & Jonathan Stokes & Damian Hodgson, 2016. "Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis," PLOS Medicine, Public Library of Science, vol. 13(9), pages 1-19, September.
    4. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2013. "Five types of OECD healthcare systems: Empirical results of a deductive classification," Health Policy, Elsevier, vol. 113(3), pages 258-269.
    5. Green, Francis, 2011. "Unpacking the misery multiplier: How employability modifies the impacts of unemployment and job insecurity on life satisfaction and mental health," Journal of Health Economics, Elsevier, vol. 30(2), pages 265-276, March.
    6. Adolf Stepan & Margit Sommersguter‐Reichmann, 2005. "Monitoring political decision‐making and its impact in Austria," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 7-23, September.
    7. Leonie Sundmacher & Thomas Kopetsch, 2015. "The impact of office-based care on hospitalizations for ambulatory care sensitive conditions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 365-375, May.
    8. Laditka, James N. & Laditka, Sarah B. & Mastanduno, Melanie P., 2003. "Hospital utilization for ambulatory care sensitive conditions: health outcome disparities associated with race and ethnicity," Social Science & Medicine, Elsevier, vol. 57(8), pages 1429-1441, October.
    9. Michael Leung, 2010. "Primary care delivery, risk pooling and economic efficiency," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(2), pages 161-175, April.
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