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

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 interregional 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.

Modeling Interregional Patient Mobility: Theory and Evidence From Spatially Explicit Data

“…Based on the number of insured individuals (i.e., potential patients), each social health insurance fund negotiates a placement plan ( Stellenplan ) with the regional chambers of physicians ( Landesärztekammern ) for each political district. The negotiated distribution of these contracted outpatient physicians is required by law to take into account differences in regional infrastructure, such that each insured person has a choice between at least two outpatient physicians who can be reached within a reasonable travel time (Renner, 2019; Stepan and Sommersguter‐Reichmann, 2005). However, although the number of public physicians is strictly regulated at the district level, physicians are free to locate anywhere within that district.…”

Doenças sistêmicas e interdisciplinaridade: a importância do diálogo entre o cirurgião dentista e o médico no tratamento e prognóstico de pessoas com enfermidades sistêmicas

“…Os achados deste trabalho corroboram com a literatura já existente na medida em que concorda que alterações sistêmicas como a diabetes mellitus e doenças cardiológicas podem ter apresentações orais e/ou que o tratamento dessas doenças influenciam na saúde bucal e, assim, uma conversa entre os profissionais de ambas as áreas é necessária. Além disso, o tratamento empregado para essas doenças, bem como o seu prognóstico pode ser melhor manejado quando as alterações orais também são levadas em conta (HUGHES et al, 2000;MARTIN-CABEZAS et al, 2016;BERLIN-BRONER et al, 2017;HOLMLUND et 2017;PIRES et al, 2017;PORTER et al, 2017 GRAZIANI et al, 2018;VAISHNAVI et al, 2019).…”

“…Ainda, pacientes que não respondem ao tratamento periodontal, possuem alto risco de doença cardiovascular (HOLMLUND et al, 2017). De acordo com as evidências apresentadas, é inquestionável que a saúde geral e a saúde oral são essenciais uma para outra (TSE, 2018;JAVAID et al, 2019;KASSIM et al, 2019;RENNER, 2020).…”

“…Por um longo período, constatou-se que alguns medicamentos, usados para tratamento dessas doenças, causam alterações no periodonto, favorecendo a progressão da doença periodontal, além de poder causar crescimento e sangramento gengival e inflamação (HUGHES et al, 2000;PIRES et al, 2017). Ademais, é importante ressaltar, que a interação medicamentosa existente entre o tratamento médico e odontológico, deve ser constantemente observada, bem como, manifestações orais de doenças sistêmicas, uma vez, que estas podem ser a primeira ou mais grave característica da patologia (PORTER et al, 2017).…”

Editorial for the Special Issue “Spatial and regional aspects of health”

“…Marshall 1991, Lawson 2018, Kulldorff, Nagarwalla 1995, Santos et al 2020, Nowakowska et al 2021, geographical distribution of healthcare services and their utilization (e.g. Santana et al 2009, Gravelle et al 2014, Longo et al 2017, Okoli et al 2020, Shinjo, Aramaki 2012, Pongiglione et al 2020, Renner 2020), E1 E2 A. Renner, R. Santos, B. Pongiglione, R. Hoffmann or environmental shocks on population health (Gemmell et al 2000, Analitis et al 2008, Almendra et al 2017.…”