On the interdependence of ambulatory and hospital care in the German health system

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• 作者：Tugba Büyükdurmus ; Thomas Kopetsch ; Hendrik Schmitz…
• 关键词：Health care ; Ambulatory care ; Hospital care ; Medical specialities ; Instrumental variables
• 刊名：Health Economics Review
• 出版年：2017
• 出版时间：December 2017
• 年：2017
• 卷：7
• 期：1
• 全文大小：651KB
• 刊物主题：Public Health; Health Economics; Public Finance; Pharmacoeconomics and Health Outcomes; Economic Policy; Health Care Management;
• 出版者：Springer Berlin Heidelberg
• ISSN：2191-1991
• 卷排序：7

文摘

For some considerable time now the interface between ambulatory and hospital care has been mooted as a cause of inefficiencies in the German health system and there have been calls for a softening of the strict separation between the two sectors. This debate emphasizes the need for detailed empirical information on the interdependence between the two sectors. Using extensive administrative data at the level of the 412 German counties for the years 2007 to 2009 and a simultaneous equation model which allows the numbers of ambulatory and hospital cases to be mutually interdependent, we examine the connection between ambulatory and hospital specialist care separately for ten medical specialties. The results show that the interdependence of ambulatory and hospital services is far from homogeneous. The relationship depends, on the one hand, on the specialty and, on the other, on the direction of the effect observed. This heterogeneity needs to be taken into account for cross-sector needs-based planning.