What works? The association of organisational structure, reforms and interventions on efficiency in treating hip fractures.

Autor: Häkkinen U; Centre for Health and Social Economics (CHESS), Finnish Institute for Health and Welfare, Finland. Electronic address: unto.hakkinen@thl.fi., Sund R; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Jazyk: angličtina
Zdroj: Social science & medicine (1982) [Soc Sci Med] 2021 Apr; Vol. 274, pp. 113611. Date of Electronic Publication: 2020 Dec 24.
DOI: 10.1016/j.socscimed.2020.113611
Abstrakt: Many studies indicate huge regional and hospital-level differences in health care performance. In order to increase health system efficiency, it is important to know the reasons behind the differences and analyse the effects of those factors that can be affected by health policy. The aim of this study is to evaluate and compare various organisational factors and health policy interventions in the performance of the care of hip fracture patients in Finland. We analysed the relationship between organisational factors (hospital volume, regional concentration of treatments) and performance. The focus is also on the effects of two macro-level organisational changes (integration of production of all health and social services in one provider) and two micro-level interventions (integrated patient pathway interventions, aiming to discharge patients as soon as possible). Our results indicate that macro-level integration of the production or financing of health and social services, bigger hospital volumes, and the concentration of the acute phase of care in fewer hospitals within hospital districts were not consistently related to efficiency in the care of hip fracture patients. Instead, efficiency can be increased using micro-level interventions aiming to coordinate patient pathways at the patient group level.
(Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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