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

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

Abstract

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

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    1. Pierre Pestieau & Gregory Ponthière, 2012. "Long-Term Care Insurance Puzzle," Palgrave Macmillan Books, in: Joan Costa-Font & Christophe Courbage (ed.), Financing Long-Term Care in Europe, chapter 3, pages 41-52, Palgrave Macmillan.
    2. 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.
    3. 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.
    4. 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, December.
    5. 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, November.
    6. 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(S1), pages 32-44, March.
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    Cited by:

    1. Brendan Walsh & Seán Lyons & Samantha Smith & Maev‐Ann Wren & James Eighan & Edgar Morgenroth, 2020. "Does formal home care reduce inpatient length of stay?," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1620-1636, December.
    2. DeVolder, Russell & Serra-Sastre, Victoria & Zamora, Bernarda, 2020. "Examining the variation across acute trusts in patient delayed discharge," Health Policy, Elsevier, vol. 124(11), pages 1226-1232.
    3. Dan Liu & Maria Lucia Pace & Maria Goddard & Rowena Jacobs & Raphael Wittenberg & Anne Mason, 2021. "Investigating the relationship between social care supply and healthcare utilization by older people in England," Health Economics, John Wiley & Sons, Ltd., vol. 30(1), pages 36-54, January.
    4. Moura, Ana, 2021. "Essays in health economics," Other publications TiSEM c93abd22-fa4a-42a5-b172-d, Tilburg University, School of Economics and Management.
    5. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2024. "Competition, quality and integrated health care," Journal of Health Economics, Elsevier, vol. 95(C).
    6. Maria Lucia Pace & Dan Liu & Maria Goddard & Rowena Jacobs & Raphael Wittenberg & Gerard McGonigal & Anne Mason, 2020. "The relationship between social care resources and healthcare utilisation by older people in England:an exploratory investigation," Working Papers 174cherp, Centre for Health Economics, University of York.
    7. Verzulli, R.; & Lippi Bruni, M.;, 2022. "The quicker the better: Fostering timely responses in public hospitals," Health, Econometrics and Data Group (HEDG) Working Papers 22/08, HEDG, c/o Department of Economics, University of York.
    8. 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.

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    More about this item

    Keywords

    Integration; Delayed discharge; Coordination; Length of stay; Survival; Social care;
    All these keywords.

    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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