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公立医院和私立医院中的独居情况及医疗服务提供者行为

Living alone and provider behaviour in public and private hospitals.

作者信息

Siciliani Luigi, Wen Jinglin, Gaughan James

机构信息

Department of Economics and Related Studies, University of York; Economics of Health and Social Care Research Unit (ESHCRU), United Kingdom.

Centre for Health Economics, University of York, United Kingdom.

出版信息

J Health Econ. 2025 Aug;102:103016. doi: 10.1016/j.jhealeco.2025.103016. Epub 2025 May 31.

Abstract

Following COVID-19, hospitals in many OECD countries are under pressure to absorb backlogs accumulated due to the suspension of health services. Reductions in length of stay can generate capacity to treat patients and increase efficiency. Personal circumstances, such as living alone, can affect how long patients stay in hospital. We test whether such non-clinical factors affect care received by patients. Several countries are experiencing an increase in the number of elderly people who live alone. Patients who live alone may lack support at home leading to delayed discharges despite being clinically fit. We test whether living alone affects length of stay of publicly-funded patients treated by public and private hospitals requiring hip replacement, a common planned surgery, in England. Private providers have stronger incentives to contain costs, which could reduce the extent to which non-clinical factors such as living alone are taken into account when providers discharge patients. Using administrative data and controlling for a rich set of patient characteristics, and hospital and local supply factors, we provide evidence that living alone increases length of stay. The effect is substantive and larger for public hospitals and older patients. It is similar for patients living in urban and rural areas, and across socioeconomic status. More broadly, the study shows that non-clinical factors can affect the care received by patients.

摘要

在新冠疫情之后,许多经合组织国家的医院面临着消化因医疗服务暂停而积累的积压病例的压力。缩短住院时间可以创造治疗患者的能力并提高效率。个人情况,如独居,会影响患者的住院时长。我们测试此类非临床因素是否会影响患者接受的护理。几个国家独居老年人的数量正在增加。独居患者在家中可能缺乏支持,导致尽管临床状况适宜但仍延迟出院。我们测试独居是否会影响在英国公立和私立医院接受髋关节置换手术(一种常见的计划性手术)的公费患者的住院时长。私立医疗服务提供者有更强的控制成本的动机,这可能会降低在患者出院时考虑独居等非临床因素的程度。通过使用行政数据并控制一系列丰富的患者特征、医院和当地供应因素,我们提供了证据表明独居会增加住院时长。这种影响在公立医院和老年患者中更为显著且更大。对于生活在城市和农村地区的患者以及不同社会经济地位的患者来说,情况类似。更广泛地说,该研究表明非临床因素会影响患者接受的护理。

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