Are waiting times for hospital admissions affected by patients' choices and mobility?

Background Waiting times for elective care have been considered a serious problem in many health care systems. A topic of particular concern has been how administrative boundaries act as barriers to efficient patient flows. In Norway, a policy combining patient's choice of hospital and removal of restriction on referrals was introduced in 2001, thereby creating a nationwide competitive referral system for elective hospital treatment. The article aims to analyse if patient choice and an increased opportunity for geographical mobility has reduced waiting times for individual elective patients. Methods A survey conducted among Norwegian somatic patients in 2004 gave information about whether the choice of hospital was made by the individual patient or by others. Survey data was then merged with administrative data on which hospital that actually performed the treatment. The administrative data also gave individual waiting time for hospital admission. Demographics, socio-economic position, and medical need were controlled for to determine the effect of choice and mobility upon waiting time. Several statistical models, including one with instrument variables for choice and mobility, were run. Results Patients who had neither chosen hospital individually nor bypassed the local hospital for other reasons faced the longest waiting times. Next were patients who individually had chosen the local hospital, followed by patients who had not made an individual choice, but had bypassed the local hospital for other reasons. Patients who had made a choice to bypass the local hospitals waited on average 11 weeks less than the first group. Conclusion The analysis indicates that a policy combining increased opportunity for hospital choice with the removal of rules restricting referrals can reduce waiting times for individual elective patients. Results were robust over different model specifications

Using routine data to monitor inequalities in an acute trust: a retrospective study

<p><b>Abstract</b></p> <p><b>Background</b></p> <p>Reducing inequalities is one of the priorities of the National Health Service. However, there is no standard system for monitoring inequalities in the care provided by acute trusts. We explore the feasibility of monitoring inequalities within an acute trust using routine data.</p> <p><b>Methods</b></p> <p>A retrospective study of hospital episode statistics from one acute trust in London over three years (2007 to 2010). Waiting times, length of stay and readmission rates were described for seven common surgical procedures. Inequalities by age, sex, ethnicity and social deprivation were examined using multiple logistic regression, adjusting for the other socio-demographic variables and comorbidities. Sample size calculations were computed to estimate how many years of data would be ideal for this analysis.</p> <p><b>Results</b></p> <p>This study found that even in a large acute trust, there was not enough power to detect differences between subgroups. There was little evidence of inequalities for the outcome and process measures examined, statistically significant differences by age, sex, ethnicity or deprivation were only found in 11 out of 80 analyses. Bariatric surgery patients who were black African or Caribbean were more likely than white patients to experience a prolonged wait (longer than 64 days, aOR = 2.47, 95% CI: 1.36-4.49). Following a coronary angioplasty, patients from more deprived areas were more likely to have had a prolonged length of stay (aOR = 1.66, 95% CI: 1.25-2.20).</p> <p><b>Conclusions</b></p> <p>This study found difficulties in using routine data to identify inequalities on a trust level. Little evidence of inequalities in waiting time, length of stay or readmission rates by sex, ethnicity or social deprivation were identified although some differences were identified which warrant further investigation. Even with three years of data from a large trust there was little power to detect inequalities by procedure. Data will therefore need to be pooled from multiple trusts to detect inequalities.</p

Altruism Heterogeneity and Quality Competition Among Healthcare Providers

New empirical evidence shows substantial heterogeneity in the altruism of healthcare providers. Spurred by this evidence, we build a spatial quality competition model with altruism heterogeneity. We find that more altruistic healthcare providers supply relatively higher quality levels and position themselves closer to the center. Whether the social planner prefers more or less horizontal differentiation is in general ambiguous and depends on the level of altruism. The more altruistic healthcare providers are, the more likely it is that the social planner prefers greater horizontal differentiation to offset costly quality competition.Neue empirische Evidenz für Leistungsanbieter im Gesundheitswesen zeigt, dass es erhebliche Heterogenität im Grad des Altruismus gibt. Auf Basis dieser neuen Evidenz entwickeln wir ein räumliches Wettbewerbsmodell, in dem Leistungsanbieter mittels Qualität konkurrieren und das für Heterogenität im Grad des Altruismus erlaubt. Wir finden, dass Leistungsanbieter, die durch einen relativ höheren Grad an Altruismus gekennzeichnet sind, auch höhere Qualitäten anbieten und sich zentraler allokieren (niedrigere horizontale Differenzierung). Ob aus der sozialen Perspektive mehr oder weniger horizontale Differenzierung bevorzugt wird, hängt von dem Grad des Altruismus ab. Je höher der Grad des Altruismus, desto wahrscheinlicher ist es, dass der Sozialplaner mehr horizontale Differenzierung bevorzugt, um den Qualitätswettbewerb einzuschränken

Psicoterapia e schizofrenia: aree di confine dei disturbi schizofrenici

Psicoterapia e schizofrenia: aree di confine dei disturbi schizofrenic

Psychotherapy for psychotics in the mental health service

Psychotherapy for psychotics in the mental health servic

Psychotherapy for psychotics in the mental health service: the South-Verona integrated strategic approach

Psychotherapy for psychotics in the mental health service: the South-Verona integrated strategic approac