Department of Economics, Eötvös Loránd University (ELTE), Pázmány Péter sétány 1/A, Budapest, 1117, Hungary.
Institute of Economics, "Lendület" Health and Population Research Group, Centre for Economic and Regional Studies, Hungarian Academy of Sciences, Budapest, Hungary.
Eur J Health Econ. 2019 Aug;20(6):801-817. doi: 10.1007/s10198-019-01043-4. Epub 2019 Mar 15.
In 2010-2012, new outpatient service locations were established in poor Hungarian micro-regions. We exploit this quasi-experiment to estimate the extent of substitution between outpatient and inpatient care. Fixed-effects Poisson models on individual-level panel data for years 2008-2015 show that the number of outpatient visits increased by 19% and the number of inpatient stays decreased by 1.6% as a result, driven by a marked reduction of potentially avoidable hospitalization (PAH) (5%). In our dynamic specification, PAH effects occur in the year after the treatment, whereas non-PAH only decreases with a multi-year lag. The instrumental variable estimates suggest that a one euro increase in outpatient care expenditures produces a 0.6 euro decrease in inpatient care expenditures. Our results (1) strengthen the claim that bringing outpatient care closer to a previously underserved population yields considerable health benefits, and (2) suggest that there is a strong substitution element between outpatient and inpatient care.
2010-2012 年，在匈牙利贫困的微观地区设立了新的门诊服务点。我们利用这一准实验来估计门诊和住院治疗之间的替代程度。基于 2008-2015 年个人层面的面板数据的固定效应泊松模型显示，门诊就诊次数增加了 19%，住院天数减少了 1.6%，这主要是由于潜在可避免住院治疗（PAH）（5%）的显著减少。在我们的动态模型中，PAH 的影响出现在治疗后的一年，而非 PAH 仅在多年后才会减少。工具变量估计表明，门诊护理支出每增加一欧元，住院护理支出就会减少 0.6 欧元。我们的研究结果（1）证实了将门诊护理服务提供给以前服务不足的人群会带来相当大的健康益处的说法，（2）表明门诊和住院治疗之间存在很强的替代关系。
