Rodriguez-Alvarez Ana, Alonso-Iglesias Eder
Department of Economics, Oviedo University, Oviedo, Spain.
Daiichi Sankyo, Madrid, Spain.
Health Econ Rev. 2024 Nov 23;14(1):96. doi: 10.1186/s13561-024-00575-7.
In this paper, we propose a novel model that allows us to understand the effect of hospital readmissions on technology and costs. To do this, we consider that hospitals may experience heterogeneous discharges: on the one hand, discharges corresponding to patients who have completed their healing process in hospital and, on the other hand, discharges resulting from patients who have been discharged too early and are therefore required to be readmitted to hospital. In the first case, discharges involve more resources; in the second case, the patient returns implying an additional use of resources. In tandem, two new issues arise which need to be addressed: a) Does a trade-off exist between the decision to discharge at the finalisation of fully completed treatment or the decision to discharge taken at an earlier stage; b) Readmissions may prove endogenous and if so, their econometric treatment must be considered in order to obtain unbiased results. Our study contributes to the literature by proposing a novel model which estimates the marginal cost of readmissions, thus allowing us to understand the effect of readmission on technology and hospital costs.
To resolve the foregoing concerns, this paper proposes a theoretical and empirical model based on the dual theory, which combines cost and input-oriented distance functions to obtain the marginal cost of readmissions. Our empirical application uses a panel of Spanish public hospitals observed over the period 2002-2016.
Results indicate that the treatment required by a patient who is readmitted proves more expensive than keeping the patient under observation for a few extra days in order to achieve a definitive discharge. Moreover, this additional cost follows an increasing temporal trend, especially in times of expansion when the availability of resources is greater.
Given that the results indicate that readmissions imply an additional cost for the hospital system, they must be contained. In fact, readmission rates are a significant component of current hospital sector activity improvement strategies. Therefore, knowing the cost which readmission implies is relevant for the design of policies that seek to penalize those hospitals with high readmission rates.
在本文中，我们提出了一种新颖的模型，该模型使我们能够了解医院再入院对技术和成本的影响。为此，我们认为医院可能会经历异质性出院情况：一方面，出院对应于已在医院完成治愈过程的患者；另一方面，出院是由于患者过早出院，因此需要再次入院。在第一种情况下，出院涉及更多资源；在第二种情况下，患者再次入院意味着资源的额外使用。同时，出现了两个需要解决的新问题：a）在完全完成治疗后决定出院与在较早阶段决定出院之间是否存在权衡；b）再入院可能是内生的，如果是这样，必须考虑对其进行计量经济学处理以获得无偏结果。我们的研究通过提出一种新颖的模型来估计再入院的边际成本，从而有助于该文献的研究，进而使我们能够了解再入院对技术和医院成本的影响。
为了解决上述问题，本文提出了一种基于对偶理论的理论和实证模型，该模型结合了成本和投入导向的距离函数来获得再入院的边际成本。我们的实证应用使用了2002年至2016年期间观察到的一组西班牙公立医院的数据。
结果表明，再次入院患者所需的治疗比让患者多观察几天以实现最终出院的成本更高。此外，这种额外成本呈上升的时间趋势，尤其是在资源可用性更高的扩张时期。
鉴于结果表明再入院意味着医院系统的额外成本，必须加以控制。事实上，再入院率是当前医院部门活动改善策略的重要组成部分。因此，了解再入院所隐含的成本对于设计旨在惩罚那些再入院率高的医院的政策至关重要。
