Who will be the mediator? Local politics and hospital closures in Germany

This paper analyses the effects of hospital closures in Germany in the context of emergency medical care for patients with acute myocardial infarction or hemorrhagic stroke. Using a comprehensive inpatient care data, I evaluate the extent of the impact of hospital closures between 2006 and 2012 on geographical healthcare access and several patient clinical outcomes. To minimize bias from the potential endogeneity between the hospital quality and market structure, I employ an instrumental variable strategy and build a strong and highly relevant instrument in the context of municipal politics. Using collected data on the turnout of each local election in Germany, I compute a measure of concentration in political power that is estimated by the winning margin of the largest centre-right political party in Germany against the opposition. My findings suggest that: first, while patients living in closure-affected areas face worse healthcare access, this does not result in lower survival for acute medical cases; second, that a hospital closure mainly affects the access for rural residents and stimulates the efficiency of hospitals located in the more densely populated areas; and political power in the area plays an important role in shaping hospital's future in the local market.Dieser Beitrag analysiert die Auswirkungen von Krankenhausschließungen in Deutschland im Kontext der notfallmedizinischen Versorgung von Patienten mit akutem Myokardinfarkt oder hämorrhagischem Schlaganfall. Unter Verwendung umfassender Daten zur stationären Versorgung evaluiere ich das Ausmaß der Auswirkungen von Krankenhausschließungen zwischen 2006 und 2012 auf den Zugang zur Gesundheitsversorgung und verschiedene klinische Ergebnisse der Patienten. Um Verzerrungen durch die potentielle Endogenität zwischen der Krankenhausqualität und der Marktstruktur zu minimieren, verwende ich einen Instrumentenvariablenansatz. Meine Ergebnisse legen nahe, dass erstens Patienten, die in von Schließungen betroffenen Gebieten leben zwar einen schlechteren Zugang zur Gesundheitsversorgung haben, dies führt aber nicht zu einer geringeren Überlebensrate bei akuten medizinischen Fällen; zweitens, dass die Schließung eines Krankenhauses vor allem den Zugang für Bewohner ländlicher Gebiete betrifft und die Effizienz von Krankenhäusern erhöht, die sich in den dichter besiedelten Gebieten befinden; und drittens die politische Macht in der Gegend eine wichtige Rolle für die Zukunft des Krankenhauses auf dem lokalen Markt spielt

Burden and Costs of Severe Burn Injury in Victoria, Australia

This study examines the costs of severe burn injury in Victoria, Australia. It quantifies the funding generated through an activity-based case-mix system for hospital treatment of acute injury and presentations in the subsequent two years and costs of the longer-term burden of burn injury due to premature burn-related deaths and disability. Severe adult burns cases in Victoria from 2007–2016 were identified using the Victorian State Trauma Registry (VSTR). Cases were linked with the Victorian Admitted Episodes Dataset (VAED), Victoria Emergency Minimum Dataset (VEMD), and the National Coronial Information System (NCIS). Hospital re-imbursements and costs of Disability-Adjusted Life Years (DALYs) were calculated using disability weights derived from the EQ-5D-3L questionnaire responses at 24 months post injury. There were 331 patients hospitalised with a burn ≥20% total body surface area (TBSA) from 2007–2016. Total mean re-imbursement (SD) for the acute treatment episode per patient in Australian dollars (AUD) was $87,570 ($97,913). There was significant variation in the number of cases by year and re-imbursement per patient, with high outliers common. Excluding 2009, when 173 people died in bushfires, there were 7749 DALYs which cost $991,872,000. Severe burns are uncommon and variable. Economic treatment costs of severe burns are high, and among survivors there is high incidence of long-term disability and overall burden of injury

Providers, Peers and Patients: How do Physicians' Practice Environments Affect Patient Outcomes?

We study the extent to which physician treatment styles are determined by their practice environment and whether such decisions affect the quality of care received by patients. Using rich data on all coronary angioplasty procedures in Sweden 2004–2013, our empirical approach compares stent choices of interventional cardiologists moving across hospitals to patient outcomes over time. To disentangle changes in practice styles attributable to physical (provider) and social (peer group) factors, we exploit quasi‐random variation on physicians working on the same day in the same hospital. Our findings suggest that (i) moving cardiologists' stent choices rapidly adapt to their new practice environment after relocation; (ii) practice style changes are equally driven by the physical and social environments; and (iii) rates of decision errors, treatment costs and adverse clinical events among treated patients remain largely unchanged despite the altered practice styles

Subjective and objective quality and choice of hospital: Evidence from maternal care services in Germany

We study patient choice of healthcare provider based on both objective and subjective quality measures in the context of maternal care hospital services in Germany. Objective measures are obtained from publicly reported clinical indicators, while subjective measures are based on satisfaction scores from a large and nationwide patient survey. We merge both quality metrics to detailed hospital discharge records and quantify the additional distance expectant mothers are willing to travel to give birth in maternity clinics with higher reported quality. Our results reveal that patients are on average willing to travel 0.1–2.7 additional kilometers for a one standard deviation increase in quality. Patients respond to both objective and subjective quality measures, suggesting that patient satisfaction scores may constitute important complements to clinical indicators when choosing provider

Subjective and objective quality reporting and choice of hospital: Evidence from maternal care services in Germany

We study patient choice of healthcare provider based on both objective and subjective quality measures in the context of maternal care hospital services in Germany. Objective measures are obtained from publicly reported clinical indicators, while subjective measures are based on satisfaction scores from a large and nationwide patient survey. We merge both quality metrics to detailed hospital discharge records and quantify the additional distance expectant mothers are willing to travel to give birth in maternity clinics with higher reported quality. Our results reveal that patients are on average willing to travel between 0.7-4.2 additional kilometers for a one standard deviation increase in reported quality. Furthermore, patients respond independently to both objective and subjective quality measures, suggesting that satisfaction scores may constitute important complements to clinical indicators when choosing healthcare provider