Regional variation in hospital care at the end-of-life of Dutch patients with lung cancer exists and is not correlated with primary and long-term care

Abstract Objective To examine the regional variation in hospital care utilization in the last 6 months of life of Dutch patients with lung cancer and to test whether higher degrees of hospital utilization coincide with less general practitioner (GP) and long-term care use. Design Cross-sectional claims data study. Setting The Netherlands. Participants Patients deceased in 2013–2015 with lung cancer (N = 25 553). Main Outcome Measures We calculated regional medical practice variation scores, adjusted for age, gender and socioeconomic status, for radiotherapy, chemotherapy, CT-scans, emergency room contacts and hospital admission days during the last 6 months of life; Spearman Rank correlation coefficients measured the association between the adjusted regional medical practice variation scores for hospital admissions and ER contacts and GP and long-term care utilization. Results The utilization of hospital services in high-using regions is 2.3–3.6 times higher than in low-using regions. The variation was highest in 2015 and lowest in 2013. For all 3 years, hospital care was not significantly correlated with out-of-hospital care at a regional level. Conclusions Hospital care utilization during the last 6 months of life of patients with lung cancer shows regional medical practice variation over the course of multiple years and seems to increase. Higher healthcare utilization in hospitals does not seem to be associated with less intensive GP and long-term care. In-depth research is needed to explore the causes of the variation and its relation to quality of care provided at the level of daily practice.

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The impact of ageing on hospital care and long-term care—the example of Germany

Health Policy ◽

10.1016/s0168-8510(03)00083-6 ◽

2004 ◽

Vol 67 (1) ◽

pp. 57-74 ◽

Cited By ~ 69

Author(s):

Erika Schulz ◽

Reiner Leidl ◽

Hans-Helmut König

Keyword(s):

Hospital Care ◽

Long Term Care ◽

Term Care ◽

The Impact

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Regional medical practice variation in high-cost healthcare services

The European Journal of Health Economics ◽

10.1007/s10198-021-01298-w ◽

2021 ◽

Author(s):

Michael Berger ◽

Thomas Czypionka

Keyword(s):

Medical Practice ◽

Regional Variation ◽

Multivariate Regression ◽

Healthcare Services ◽

Practice Variation ◽

District Level ◽

Healthcare Data ◽

Regional Medical ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri

AbstractMagnetic resonance imaging (MRI) is a popular yet cost-intensive diagnostic measure whose strengths compared to other medical imaging technologies have led to increased application. But the benefits of aggressive testing are doubtful. The comparatively high MRI usage in Austria in combination with substantial regional variation has hence become a concern for its policy makers. We use a set of routine healthcare data on outpatient MRI service consumption of Austrian patients between Q3-2015 and Q2-2016 on the district level to investigate the extent of medical practice variation in a two-step statistical analysis combining multivariate regression models and Blinder–Oaxaca decomposition. District-level MRI exam rates per 1.000 inhabitants range from 52.38 to 128.69. Controlling for a set of regional characteristics in a multivariate regression model, we identify payer autonomy in regulating access to MRI scans as the biggest contributor to regional variation. Nevertheless, the statistical decomposition highlights that more than 70% of the regional variation remains unexplained by differences between the observable district characteristics. In the absence of epidemiological explanations, the substantial regional medical practice variation calls the efficiency of resource deployment into question.

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Predictors of Long-Term Care Utilization by Dutch Hospital Patients aged 65+

BMC Health Services Research ◽

10.1186/1472-6963-10-110 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 32

Author(s):

Albert Wong ◽

Rianne Elderkamp-de Groot ◽

Johan Polder ◽

Job van Exel

Keyword(s):

Long Term Care ◽

Care Utilization ◽

Dutch Hospital ◽

Term Care ◽

Hospital Patients

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The Impacts of Long-Term Care Insurance on Health Care Utilization and Expenditure: Evidence From China

Health Policy and Planning ◽

10.1093/heapol/czac003 ◽

2022 ◽

Author(s):

He Chen ◽

Jing Ning

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Treatment Effect ◽

Health Expenditure ◽

Long Term Care ◽

Care Utilization ◽

Ageing Population ◽

Term Care ◽

Long Term Care Insurance

Abstract Long-term care insurance (LTCI) is one of the important institutional responses to the growing care needs of the ageing population. Although previous studies have evaluated the impacts of LTCI on health care utilization and expenditure in developed countries, whether such impacts exist in developing countries is unknown. The Chinese government has initiated policy experimentation on LTCI to cope with the growing and unmet need for aged care. Employing a quasi-experiment design, this study aims to examine the policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure in China. The Propensity Score Matching with Difference-in-difference approach was used to analyse the data obtained from four waves of China Health and Retirement Longitudinal Study (CHARLS). Our findings indicated that, in the aspect of health care utilization, the introduction of LTCI significantly reduced the number of outpatient visits by 0.322 times (p<0.05), the number of hospitalizations by 0.158 times (p<0.01), and the length of inpatient stay during last year by 1.441 days (p<0.01). In the aspect of out-of-pocket health expenditure, we found that LTCI significantly reduced the inpatient out-of-pocket health expenditure during last year by 533.47 yuan (p<0.01), but it did not exhibit an impact on the outpatient out-of-pocket health expenditure during last year. LTCI also had a significantly negative impact on the total out-of-pocket health expenditure by 512.56 yuan. These results are stable in the robustness tests. Considering the evident policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure, the expansion of LTCI could help reduce the needs for health care services and contain the increases in out-of-pocket health care expenditure in China.

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