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.
Highlights
Healthcare expenditures represent a substantial part of the public budget in many European countries1 and are projected to increase due to demographic changes and increasingly expensive new treatments
This finding is confirmed by a likelihood ratio test which shows that the Null hypothesis of the additional parameters in the Spatial Durbin Error Model (SDEM) compared to the Spatial Error Model (SEM) being all zero cannot be rejected at a 99% level
Austria is unique in its strict regulatory split between outpatient and inpatient healthcare sector
Summary
Healthcare expenditures represent a substantial part of the public budget in many European countries and are projected to increase due to demographic changes and increasingly expensive new treatments Based on these projections and in light of the most recent economic crises, reducing or limiting the growth of healthcare spending are considered relevant austerity measures [2]. Given that healthcare can be received free of economically relevant co-payments, a sick person’s decision if, where and when to enter the healthcare system depends (1) on the probability that the health problem will dissolve (i.e. subjective need), (2) on the individual (time) preferences of the patient, and (3) on the relative disutility of visiting a doctor This relative disutility is determined by the availability
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
