On Monday April 16, 2018, 14:00 - 15:30 Norman Bannenberg (University Duisburg-Essen) will present:
The Impact of Preventive Home Visits on Utilization, Costs, and Staffing of Home-Based and Nursing Home Care
Countries are struggling with the consequences of an ageing population in terms of increased demand for long-term care services. An important policy issue is to create a composition of services that restrains resource use without impacting negatively on health and well-being for the elderly. In this respect, to prevent or at least to delay nursing home admissions is crucial. Preventive home visits (PHV) are types of programs that have been introduced in several countries in different varieties. The purpose is to support autonomy and independence as well as preventing disability and nursing home admissions. Older people are visited by a nurse to assess the various aspects of their health condition followed by initiation of preventive measures. Previous studies show somewhat conflicting results regarding the effects of PHV on disability and composition of care services. This study contributes to the literature by exploiting a natural experiment that covers all Norwegian municipalities. Hence, the study is population-based and follows subjects over a long time period, which is important since both since public health interventions may not show immediate effect and also, the effect may decline over time. We predict that PHV will increase the use of home-based services and reduce the number of nursing home residents. The design allows for applying a difference-in-differences approach to study potentially causal effects of the PHV. Results indicate that the introduction of a PHV program leads to an increase in the use of home-based care of about 5 percentage points and a reduction of the share of people in nursing homes of about 3.5 percentage points. Several robustness checks support the findings. An important follow-up would be to study the implications in terms of social costs and older people’s physical and mental health conditions.
Room: WST-C.02.12, Weststadttürme Berliner Platz 6-8, Essen.
Prospective payment systems incentivise providers to reduce production costs and adopt more efficient care pathways. When these incentives are insufficient or adoption is judged to be too slow, payers may decide to reimburse providers in excess of their production cost to accelerate adoption. The National Health Service in England introduced a pay-for-efficiency (P4E) policy in 2010 to reduce overnight hospital stays in favour of ambulatory care (i.e. day case surgery). For 32 conditions, hospitals now receive a higher DRG tariff for ambulatory care than for inpatient care, even though the marginal cost of production of ambulatory care is already lower. In this talk I will present results of a quasi-experimental evaluation of the P4E policy and discuss some of the methodological challenges in evaluating 32 different experiments as part of a single study.
Room: WST-C.02.12, Weststadttürme Berliner Platz 6-8, Essen
On Monday January 22, 2018, 14:00 - 15:30 Ieva Sriubaite (CINCH) will present:
Go your own way? The importance of environment in the formation of physician practice styles
Variations in regional health care expenditures are sometimes attributed to discretion in physician’s treatment decisions. It is less clear how such discretion translates into changes in quality of care. This paper contributes to the recent literature on provider practice styles by studying the extent to which treatment heterogeneity arise from physician and environment-specific factors, respectively, and relate this to changes in patient outcomes. We adapt an empirical approach similar to that of Molitor (2016), exploiting cardiologist migration across hospital regions in the US, and use administrative data on all coronary catheterization procedures performed in Swedish hospitals 2004-2015, together with detailed information on patients’ clinical health. Results indicate that cardiologists rapidly and strongly adapt their treatment style to the new environment after relocating. This effect appears to be mainly driven by peers. Furthermore, we find no indication that the changes in practice style have important effects on the quality of care.
Room: WST-C.02.11, Weststadttürme Berliner Platz 6-8, Essen