Department of Economics, University of Cantabria, Santander, Avda de Los Castros s/n, 39005, Spain; Cardiff Business School, Cardiff University, Cardiff, CF10 3EU, Wales, UK.
Cardiff Business School, Cardiff University, Cardiff, CF10 3EU, Wales, UK.
Soc Sci Med. 2022 Aug;307:115188. doi: 10.1016/j.socscimed.2022.115188. Epub 2022 Jul 3.
Vertical integration of health and social care organizations is widely regarded as an effective way to deliver improved outcomes for recipients of the services provided by those organizations. We test this hypothesis by investigating the impact of the creation of integration authorities in Scotland - statutory bodies responsible for planning and resourcing adult social care, primary care, community health and unscheduled hospital care at the local level. Employing a difference-in-difference style analysis we compare delayed discharges and premature mortality rates in Scottish integration authorities with those for local authority areas in the North of England for the period 2013-2019. The results suggest that health and social care integration led to improved performance on delayed discharges in Scotland (point estimate, -0.236; 95% confidence interval, -0.443, -0.029), but that premature mortality rates remained unchanged. These findings suggest that the vertical integration of local health and social care organizations may enhance organizational efficiency and patient experience, but that improvements on broader indicators of population health are more difficult to achieve.
医疗机构与社会福利机构的垂直整合被广泛认为是为这些机构所提供服务的接受者提供改善结果的有效途径。我们通过调查苏格兰整合当局的创建对服务提供的影响来验证这一假设，这些当局是负责规划和配置成人社会关怀、初级保健、社区卫生和非计划性医院护理的法定机构，在地方一级。我们采用双重差分分析方法，将 2013 年至 2019 年期间苏格兰整合当局与英格兰北部地方当局的延迟出院率和过早死亡率进行比较。结果表明，苏格兰的医疗和社会保健整合在延迟出院方面的表现有所改善（点估计数为-0.236；95%置信区间为-0.443，-0.029），但过早死亡率保持不变。这些发现表明，地方卫生和社会保健组织的垂直整合可能会提高组织效率和患者体验，但更难实现更广泛的人口健康指标的改善。
