Additional reimbursement for outpatient physicians treating nursing home residents reduces avoidable hospital admissions: Results of a reimbursement change in Germany

Abstract

Potentially avoidable hospitalizations of nursing home residents are costly and may even be harmful for the residents concerned. This study analyzes whether the introduction, in Germany in 2016, of an additional reimbursement for outpatient care physicians treating nursing home residents has led to a reduction in hospital admissions. This analysis exploits the introduction of the additional reimbursement in a difference-in-difference approach, using recipients of professional home care as a control. The analysis is based on claims data from the largest German sickness fund, which provide complete information on health care and long-term care utilization for each insured person. Our analysis highlights a 5-percent reduction in overall hospital stays and an 8-percent reduction in ambulatory care-sensitive admissions as a result of the additional reimbursements. However, we found no effect for short-term hospital admissions or for admissions at night or at the weekend. We conclude that the overall health care utilization for nursing home patients seems to have improved due to an increased presence of physicians in nursing homes during daytime working hours. Thus, an additional reimbursement for outpatient care physicians seems to be an effective tool to reduce potentially avoidable hospital admissions in the nursing home sector. However, it does not appear to improve emergency care utilization, especially out-of-hour.