IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v21y2020i1d10.1007_s10198-019-01113-7.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10198-019-01113-7
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10198-019-01113-7?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mühlichen, Michael & Lerch, Mathias & Sauerberg, Markus & Grigoriev, Pavel, 2023. "Different health systems – Different mortality outcomes? Regional disparities in avoidable mortality across German-speaking Europe, 1992–2019," Social Science & Medicine, Elsevier, vol. 329(C).
    2. Spycher, Jacques & Morisod, Kevin & Moschetti, Karine & Le Pogam, Marie-Annick & Peytremann-Bridevaux, Isabelle & Bodenmann, Patrick & Cookson, Richard & Rodwin, Victor & Marti, Joachim, 2024. "Potentially avoidable hospitalizations and socioeconomic status in Switzerland: A small area-level analysis," Health Policy, Elsevier, vol. 139(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Anna-Theresa Renner & Dieter Pennerstorfer, 2020. "Modeling inter-regional patient mobility: Does distance go far enough?," Economics working papers 2020-04, Department of Economics, Johannes Kepler University Linz, Austria.
    2. Eve Caroli & Mathilde Godard, 2016. "Does job insecurity deteriorate health?," Health Economics, John Wiley & Sons, Ltd., vol. 25(2), pages 131-147, February.
    3. Federico Belotti & Joanna Kopinska & Alessandro Palma & Andrea Piano Mortari, 2022. "Health status and the Great Recession. Evidence from electronic health records," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1770-1799, August.
    4. Teresa Leão & Inês Campos-Matos & Clare Bambra & Giuliano Russo & Julian Perelman, 2018. "Welfare states, the Great Recession and health: Trends in educational inequalities in self-reported health in 26 European countries," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-14, February.
    5. Lefgren, Lars J. & Stoddard, Olga B. & Stovall, John E., 2021. "Rationalizing self-defeating behaviors: Theory and evidence," Journal of Health Economics, Elsevier, vol. 76(C).
    6. Ammi, Mehdi & Fortier, Grant, 2017. "The influence of welfare systems on pay-for-performance programs for general practitioners: A critical review," Social Science & Medicine, Elsevier, vol. 178(C), pages 157-166.
    7. repec:dau:papers:123456789/13646 is not listed on IDEAS
    8. Jan Eichhorn, 2013. "Unemployment Needs Context: How Societal Differences between Countries Moderate the Loss in Life-Satisfaction for the Unemployed," Journal of Happiness Studies, Springer, vol. 14(6), pages 1657-1680, December.
    9. Papageorgiou, Athanasios, 2018. "The Effect of Immigration on the Well-Being of Native Populations: Evidence from the United Kingdom," MPRA Paper 93045, University Library of Munich, Germany.
    10. M. Kamrul Islam & Egil Kjerstad, 2019. "Co-ordination of health care: the case of hospital emergency admissions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(4), pages 525-541, June.
    11. Zwysen, Wouter, 2013. "Where you go depends on where you come from: the influence of father’s employment status on young adult’s labour market experiences," ISER Working Paper Series 2013-24, Institute for Social and Economic Research.
    12. Rudi Wielers & Peter H. Meer, 2021. "Beyond Income: Why We Want to Keep on Working Even if We Don’t Need the Money," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 16(4), pages 1613-1635, August.
    13. Blanchflower, David G. & Oswald, Andrew J., 2011. "Antidepressants and Age," IZA Discussion Papers 5785, Institute of Labor Economics (IZA).
    14. repec:bla:glopol:v:8:y:2017:i:s2:p:5-6 is not listed on IDEAS
    15. Anthony Lepinteur, 2021. "The asymmetric experience of gains and losses in job security on health," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2217-2229, September.
    16. Matteo Picchio & Michele Ubaldi, 2023. "Intergenerational Scars: The Impact Of Parental Unemployment On Individual Health Later In Life," Working Papers 478, Universita' Politecnica delle Marche (I), Dipartimento di Scienze Economiche e Sociali.
    17. Pinchbeck, Edward W., 2019. "Convenient primary care and emergency hospital utilisation," Journal of Health Economics, Elsevier, vol. 68(C).
    18. Olivier Jacques & Alain Noel, 2022. "Austerity Reduces Public Health Investment," CIRANO Working Papers 2022s-02, CIRANO.
    19. Freise, Diana & Schmitz, Hendrik & Westphal, Matthias, 2022. "Late-career unemployment and cognitive abilities," Journal of Health Economics, Elsevier, vol. 86(C).
    20. Francis Green, 2020. "Health effects of job insecurity," IZA World of Labor, Institute of Labor Economics (IZA), pages 212-212, December.
    21. Clemens, Timo & Michelsen, Kai & Commers, Matt & Garel, Pascal & Dowdeswell, Barrie & Brand, Helmut, 2014. "European hospital reforms in times of crisis: Aligning cost containment needs with plans for structural redesign?," Health Policy, Elsevier, vol. 117(1), pages 6-14.
    22. Agata Łaszewska & Ayesha Sajjad & Jan Busschbach & Judit Simon & Leona Hakkaart-van Roijen, 2022. "Conceptual Framework for Optimised Proxy Value Set Selection Through Supra-National Value Set Development for the EQ-5D Instruments," PharmacoEconomics, Springer, vol. 40(12), pages 1221-1234, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:eujhec:v:21:y:2020:i:1:d:10.1007_s10198-019-01113-7. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.