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

Author

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  • Yuxi Wang

    (Bocconi University)

  • Simone Ghislandi

    (Bocconi University)

  • Aleksandra Torbica

    (Bocconi University)

Abstract

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.

Suggested Citation

  • Yuxi Wang & Simone Ghislandi & Aleksandra Torbica, 2020. "Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1149-1168, November.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:8:d:10.1007_s10198-020-01221-9
    DOI: 10.1007/s10198-020-01221-9
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    as
    1. Laurent Gobillon & Carine Milcent, 2013. "Spatial disparities in hospital performance," Journal of Economic Geography, Oxford University Press, vol. 13(6), pages 1013-1040, November.
    2. Kathleen Carey & James F. Burgess, 1999. "On measuring the hospital cost/quality trade‐off," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 509-520, September.
    3. Kathleen Carey, 2015. "Measuring the Hospital Length of Stay/Readmission Cost Trade‐Off Under a Bundled Payment Mechanism," Health Economics, John Wiley & Sons, Ltd., vol. 24(7), pages 790-802, July.
    4. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    5. Cavalieri, Marina & Gitto, Lara & Guccio, Calogero, 2013. "Reimbursement systems and quality of hospital care: An empirical analysis for Italy," Health Policy, Elsevier, vol. 111(3), pages 273-289.
    6. Nils Gutacker & Andrew Street, 2018. "Multidimensional performance assessment of public sector organisations using dominance criteria," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 13-27, February.
    7. Propper, Carol & Burgess, Simon & Green, Katherine, 2004. "Does competition between hospitals improve the quality of care?: Hospital death rates and the NHS internal market," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1247-1272, July.
    8. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    9. Sverre A. C. Kittelsen & Kjartan S. Anthun & Fanny Goude & Ingrid M. S. Huitfeldt & Unto Häkkinen & Marie Kruse & Emma Medin & Clas Rehnberg & Hanna Rättö & on behalf of the EuroHOPE study group, 2015. "Costs and Quality at the Hospital Level in the Nordic Countries," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 140-163, December.
    10. Eddy van Doorslaer & Cristina Masseria, 2004. "Income-Related Inequality in the Use of Medical Care in 21 OECD Countries," OECD Health Working Papers 14, OECD Publishing.
    11. Berta, Paolo & Callea, Giuditta & Martini, Gianmaria & Vittadini, Giorgio, 2010. "The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: A population-based investigation," Economic Modelling, Elsevier, vol. 27(4), pages 812-821, July.
    12. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    13. Mauro, Marianna & Maresso, Anna & Guglielmo, Annamaria, 2017. "Health decentralization at a dead-end: towards new recovery plans for Italian hospitals," Health Policy, Elsevier, vol. 121(6), pages 582-587.
    14. Ferrè, Francesca & Cuccurullo, Corrado & Lega, Federico, 2012. "The challenge and the future of health care turnaround plans: Evidence from the Italian experience," Health Policy, Elsevier, vol. 106(1), pages 3-9.
    15. Sverre A. C. Kittelsen & Kjartan S. Anthun & Fanny Goude & Ingrid M. S. Huitfeldt & Unto Häkkinen & Marie Kruse & Emma Medin & Clas Rehnberg & Hanna Rättö & on behalf of the EuroHOPE study group, 2015. "Costs and Quality at the Hospital Level in the Nordic Countries," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 140-163, December.
    16. Niccie L. McKay & Mary E. Deily, 2008. "Cost inefficiency and hospital health outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 17(7), pages 833-848, July.
    17. Tom Stargardt & Jonas Schreyögg & Ivan Kondofersky, 2014. "Measuring The Relationship Between Costs And Outcomes: The Example Of Acute Myocardial Infarction In German Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 23(6), pages 653-669, June.
    18. Peter C. Austin, 2017. "A Tutorial on Multilevel Survival Analysis: Methods, Models and Applications," International Statistical Review, International Statistical Institute, vol. 85(2), pages 185-203, August.
    19. Afsaneh Bjorvatn, 2013. "Hospital readmission among elderly patients," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(5), pages 809-820, October.
    20. Cavalieri, M. & Guccio, C. & Lisi, D. & Pignataro, G., 2015. "Does the Extent of Per-Case Payment System Affect Hospital Efficiency? Evidence from the Italian NHS," Health, Econometrics and Data Group (HEDG) Working Papers 15/29, HEDG, c/o Department of Economics, University of York.
    21. Castelli, Adriana & Jacobs, Rowena & Goddard, Maria & Smith, Peter C., 2013. "Health, policy and geography: Insights from a multi-level modelling approach," Social Science & Medicine, Elsevier, vol. 92(C), pages 61-73.
    22. Brenna, Elenka, 2011. "Quasi-market and cost-containment in Beveridge systems: The Lombardy model of Italy," Health Policy, Elsevier, vol. 103(2), pages 209-218.
    23. Mary Margaret Ford & Linda D Highfield, 2016. "Exploring the Spatial Association between Social Deprivation and Cardiovascular Disease Mortality at the Neighborhood Level," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-17, January.
    24. Nuti, Sabina & Vola, Federico & Bonini, Anna & Vainieri, Milena, 2016. "Making governance work in the health care sector: evidence from a ‘natural experiment’ in Italy," Health Economics, Policy and Law, Cambridge University Press, vol. 11(1), pages 17-38, January.
    25. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    26. Longo, Francesco, 2016. "Lessons from the Italian NHS retrenchment policy," Health Policy, Elsevier, vol. 120(3), pages 306-315.
    27. Westert, Gert P. & Lagoe, Ronald J. & Keskimaki, Ilmo & Leyland, Alastair & Murphy, Mark, 2002. "An international study of hospital readmissions and related utilization in Europe and the USA," Health Policy, Elsevier, vol. 61(3), pages 269-278, September.
    28. Mikko Peltola & Timo T. Seppälä & Antti Malmivaara & Éva Belicza & Dino Numerato & Fanny Goude & Eilidh Fletcher & Richard Heijink, 2015. "Individual and Regional‐level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 24, pages 38-52, December.
    29. Mauro, Marianna & Maresso, Anna & Guglielmo, Annamaria, 2017. "Health decentralization at a dead-end: towards new recovery plans for Italian hospitals," LSE Research Online Documents on Economics 74066, London School of Economics and Political Science, LSE Library.
    30. Bordignon, Massimo & Turati, Gilberto, 2009. "Bailing out expectations and public health expenditure," Journal of Health Economics, Elsevier, vol. 28(2), pages 305-321, March.
    31. Luca Lorenzoni & Alberto Marino, 2017. "Understanding variations in hospital length of stay and cost: Results of a pilot project," OECD Health Working Papers 94, OECD Publishing.
    32. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
    33. Marina Cavalieri & Calogero Guccio & Domenico Lisi & Giacomo Pignataro, 2018. "Does the Extent of per Case Payment System Affect Hospital Efficiency?," Public Finance Review, , vol. 46(1), pages 117-149, January.
    34. James Vaupel & Kenneth Manton & Eric Stallard, 1979. "The impact of heterogeneity in individual frailty on the dynamics of mortality," Demography, Springer;Population Association of America (PAA), vol. 16(3), pages 439-454, August.
    35. repec:hal:pseose:halshs-00879787 is not listed on IDEAS
    36. Mikko Peltola & Timo T. Seppälä & Antti Malmivaara & Éva Belicza & Dino Numerato & Fanny Goude & Eilidh Fletcher & Richard Heijink & on behalf of the EuroHOPE study group, 2015. "Individual and Regional‐level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 38-52, December.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 26th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-26 12:00:03

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    2. García-Corchero, Juan David & Jiménez-Rubio, Dolores, 2022. "How do policy levers shape the quality of a national health system?," Journal of Policy Modeling, Elsevier, vol. 44(1), pages 203-221.

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    More about this item

    Keywords

    Geographic variation; Readmission; Rehospitalisation; Italy; Quality of care; Length of stay;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement

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