Can integrated care improve the efficiency of hospitals? Research based on 200 Hospitals in China View Full Text


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Article Info

DATE

2021-09-22

AUTHORS

Zixuan Peng, Li Zhu, Guangsheng Wan, Peter C. Coyte

ABSTRACT

BACKGROUND: The shift towards integrated care (IC) represents a global trend towards more comprehensive and coordinated systems of care, particularly for vulnerable populations, such as the elderly. When health systems face fiscal constraints, integrated care has been advanced as a potential solution by simultaneously improving health service effectiveness and efficiency. This paper addresses the latter. There are three study objectives: first, to compare efficiency differences between IC and non-IC hospitals in China; second, to examine variations in efficiency among different types of IC hospitals; and finally, to explore whether the implementation of IC impacts hospital efficiency. METHODS: This study uses Data Envelopment Analysis (DEA) to calculate efficiency scores among a sample of 200 hospitals in H Province, China. Tobit regression analysis was performed to explore the influence of IC implementation on hospital efficiency scores after adjustment for potential confounding. Moreover, the association between various input and output variables and the implementation of IC was investigated using regression techniques. RESULTS: The study has four principal findings: first, IC hospitals, on average, are shown to be more efficient than non-IC hospitals after adjustment for covariates. Holding output constant, IC hospitals are shown to reduce their current input mix by 12% and 4% to achieve optimal efficiency under constant and variable returns-to-scale, respectively, while non-IC hospitals have to reduce their input mix by 26 and 20% to achieve the same level of efficiency; second, with respect to the efficiency of each type of IC, we show that higher efficiency scores are achieved by administrative and virtual IC models over a contractual IC model; third, we demonstrate that IC influences hospitals efficiency by impacting various input and output variables, such as length of stay, inpatient admissions, and staffing; fourth, while bed density per nurse was positively associated with hospital efficiency, the opposite was shown for bed density per physician. CONCLUSIONS: IC has the potential to promote hospital efficiency by influencing an array of input and output variables. Policies designed to facilitate the implementation of IC in hospitals need to be cognizant of the complex way IC impacts hospital efficiency. More... »

PAGES

61

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  • 2001-12. Using Propensity Scores to Help Design Observational Studies: Application to the Tobacco Litigation in HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY
  • 2017-03-23. Relationships between structure, process and outcome to assess quality of integrated chronic disease management in a rural South African setting: applying a structural equation model in BMC HEALTH SERVICES RESEARCH
  • 2019-03-28. Feasibility, acceptability, and effectiveness of young people-specific, integrated out-of-hospital services: a protocol for a systematic review in SYSTEMATIC REVIEWS
  • 2016-02-15. The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point in BMC GERIATRICS
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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/34551789


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