Abstract
BackgroundThe shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, particularly for vulnerable populations, such as the elderly. When health systems face fiscal constraints, integrated care has been advanced as a potential solution by simultaneously improving health service effectiveness and efficiency. This paper addresses the latter. There are three study objectives: first, to compare efficiency differences between IC and non-IC hospitals in China; second, to examine variations in efficiency among different types of IC hospitals; and finally, to explore whether the implementation of IC impacts hospital efficiency.MethodsThis study uses Data Envelopment Analysis (DEA) to calculate efficiency scores among a sample of 200 hospitals in H Province, China. Tobit regression analysis was performed to explore the influence of IC implementation on hospital efficiency scores after adjustment for potential confounding. Moreover, the association between various input and output variables and the implementation of IC was investigated using regression techniques.ResultsThe study has four principal findings: first, IC hospitals, on average, are shown to be more efficient than non-IC hospitals after adjustment for covariates. Holding output constant, IC hospitals are shown to reduce their current input mix by 12% and 4% to achieve optimal efficiency under constant and variable returns-to-scale, respectively, while non-IC hospitals have to reduce their input mix by 26 and 20% to achieve the same level of efficiency; second, with respect to the efficiency of each type of IC, we show that higher efficiency scores are achieved by administrative and virtual IC models over a contractual IC model; third, we demonstrate that IC influences hospitals efficiency by impacting various input and output variables, such as length of stay, inpatient admissions, and staffing; fourth, while bed density per nurse was positively associated with hospital efficiency, the opposite was shown for bed density per physician.ConclusionsIC has the potential to promote hospital efficiency by influencing an array of input and output variables. Policies designed to facilitate the implementation of IC in hospitals need to be cognizant of the complex way IC impacts hospital efficiency.
Highlights
The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, for vulnerable populations, such as the elderly
Our results suggest that the type of IC had a differential effect on hospital efficiency with vertical and administrative integration models yielding higher efficiency scores compared to the contractual integration model
This study has demonstrated the potential gains to hospital efficiency in China associated with the adoption of IC
Summary
The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, for vulnerable populations, such as the elderly. Like many other countries, is facing both a greying of the population and an increased prevalence of chronic, non-communicable diseases. Those over 65 years of age represented 11.9% of the population in 2018 but are expected to account for 20% by 2040 [1, 2]. Under the twin pressures of ageing and a high prevalence of chronic diseases, integrated care has been proposed as a potential solution for China. IC encompasses various methods of funding, organization and delivery of care to enhance system efficiency [6, 8,9,10] Health systems realize their goals at all levels through enhanced hospital performance [11].
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