Periodic Reporting for period 1 - PoS (The price of success: what is the impact of improving patients’ survival on utilisation of care?)
Période du rapport: 2019-09-01 au 2021-08-31
R1: What is the impact of improving patient survival on subsequent costs of care?
R2: Is the impact of the survival effect different according to patient’s characteristics?
R3: To what extent can primary care reduce the use and costs of emergency secondary care?
Then, we examined the impact of variation in hospitals' ability to save the life of their patients on the demand for health care by using a direct approach. We found that the demand for health care is highly responsive to variation in hospitals’ ability to extend the life expectancy of their patients: a one percent variation results in a 6.3% increment in the demand for individuals with a heart attack and 5.3% for individuals with a stroke.
Our study suggests that the hospitals’ success in saving the life of individuals suffering a health shock can be an important driver of the demand for health care. This may have important implications for policy makers in planning the targets and resources for the national health system. In particular, health policies aiming at reducing the mortality of high-risk health conditions by improving the quality of care should be accompanied by additional resources to address the demand of care of an increasing number of individuals surviving such conditions.
Finally, we investigated the relationship between the demand for primary care and emergency secondary care and measure to what extent it is possible to reduce utilisation of the latter by increasing the utilisation of the former. Emergency care is associated with higher costs and poorer health outcomes than primary care for similar health conditions, thus resulting in inefficient allocation of resources and suboptimal health outcomes for the population. We proposed a new econometric model that allows for estimating the potential substitution effect between primary and emergency care. We provided an application of the new model to the study of the demand for primary and emergency care in individuals who are exposed to a health shock to their circulatory system. We found evidence of a substitution effect with an additional primary care visit reducing emergency care visits by 12.6 percentage points suggesting a fair scope for intervention to policies aiming at redirecting part of the demand of care from emergency to primary care.
We expanded the scope of existing literature investigating the impact of time to death on individual health care expenditure. Existing studies examine variation in time to death that steams from the characteristics of the demand for health care, e.g. variation in proximity to death due to age and morbidity. We showed that variation in time to death produced by variation in the supply of care has an important impact on health care expenditure that adds to demand-driven variation. Technological progress directed to extending life expectancy after a health shock may result in increasing health expenditure if individuals do not fully recover and continue to contribute to the demand for health care after the shock. Supply-driven variation in time to death may have an effect on the demand of care that may become increasingly relevant for an aging population as the risk of a health shock increases with age.
Finally, we formulated a new econometric model to study the potential substitution between primary care and emergency secondary care. The model extends the class of latent class models for longitudinal count data to the bivariate case by using a hidden Markov chain approach. The proposed new model extends the scope of previous studies by removing the need of an exogenous source of variation for identifying the model, thus allowing the researcher to test for a substitution effect in any segment of the demand of primary care and emergency secondary care. This could be particularly important from a policy perspective as it allows for exploring the potential scope of a new policy before the latter is implemented in a pilot or countrywide.