Häkkinen Unto, Rosenqvist Gunnar, Iversen Tor, Rehnberg Clas, Seppälä Timo T
Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.
Hanken School of Economics, Helsinki, Finland.
Health Econ. 2015 Dec;24 Suppl 2:116-39. doi: 10.1002/hec.3270.
The aim of the present study was to compare the quality (survival), use of resources and their relationship in the treatment of three major conditions (acute myocardial infarction (AMI), stroke and hip fracture), in hospitals in five European countries (Finland, Hungary, Italy, Norway and Sweden). The comparison of quality and use of resources was based on hospital-level random effects models estimated from patient-level data. After examining quality and use of resources separately, we analysed whether a cost-quality trade-off existed between the hospitals. Our results showed notable differences between hospitals and countries in both survival and use of resources. Some evidence would support increasing the horizontal integration: higher degrees of concentration of regional AMI care were associated with lower use of resources. A positive relation between cost and quality in the care of AMI patients existed in Hungary and Finland. In the care of stroke and hip fracture, we found no evidence of a cost-quality trade-off. Thus, the cost-quality association was inconsistent and prevailed for certain treatments or patient groups, but not in all countries.
本研究旨在比较欧洲五个国家（芬兰、匈牙利、意大利、挪威和瑞典）的医院在治疗三种主要疾病（急性心肌梗死（AMI）、中风和髋部骨折）时的质量（生存率）、资源利用情况及其相互关系。质量和资源利用情况的比较基于从患者层面数据估计的医院层面随机效应模型。在分别考察质量和资源利用情况后，我们分析了医院之间是否存在成本-质量权衡。我们的结果显示，医院和国家之间在生存率和资源利用方面存在显著差异。一些证据支持加强横向整合：区域AMI护理的更高集中程度与更低的资源利用相关。在匈牙利和芬兰，AMI患者护理的成本与质量之间存在正相关关系。在中风和髋部骨折护理方面，我们没有发现成本-质量权衡的证据。因此，成本-质量关联并不一致，在某些治疗或患者群体中存在，但并非在所有国家都存在。
