The Causal Effect of Community Hospitals on General Hospital Admissions. Evaluation of a Natural Experiment Using Register Data

VARIABLES	2010	2011	2012	2013	2014	2015	2016	2017
Acute admissions, Medical departments	1.76	1.72	1.71	1.70	1.70	1.68	1.65	1.66
Acute admissions, Surgery departments	0.31	0.30	0.29	0.29	0.28	0.28	0.29	0.28
Acute day stay, Medical departments	0.07	0.07	0.07	0.07	0.01	0.01	0.01	0.01
Acute day stay, Surgical departments	0.02	0.02	0.02	0.02	0.09	0.08	0.08	0.09
Elective admissions, Medical departments	0.23	0.24	0.24	0.25	0.27	0.27	0.26	0.25
Elective admissions, Surgical departments	0.25	0.25	0.25	0.25	0.27	0.27	0.27	0.27
Elective day stay, Medical departments	0.07	0.05	0.05	0.04	0.01	0.01	0.01	0.01
Elective day stay, Surgical departments	0.36	0.32	0.32	0.30	0.33	0.33	0.34	0.35

Average monthly admissions per 1000 inhabitants. Population <80 years. Weighted by municipal population (2010–2017).

VARIABLES	2010	2011	2012	2013	2014	2015	2016	2017
Acute admissions, Medical departments	6.02	5.87	5.80	5.78	5.73	5.75	5.66	5.67
Acute admissions, Surgery departments	1.93	1.88	1.89	1.83	1.80	1.84	1.81	1.80
Acute day stay, Medical departments	0.63	0.62	0.65	0.63	0.03	0.02	0.03	0.02
Acute day stay, Surgical departments	0.32	0.31	0.29	0.28	0.86	0.86	0.84	0.84
Elective admissions, Medical departments	2.03	2.12	2.09	2.12	2.05	2.07	2.05	2.02
Elective admissions, Surgical departments	2.27	2.32	2.31	2.33	2.40	2.38	2.41	2.36
Elective day stay, Medical departments	0.91	0.78	0.71	0.61	0.05	0.04	0.04	0.04
Elective day stay, Surgical departments	3.60	3.64	3.66	3.54	4.10	4.03	3.82	3.80

Independent variables. Average per year, 2010–2017. Weighted by municipal population.

INDEPENDENT VARIABLES	2010	2011	2012	2013	2014	2015	2016	2017
Nursing home places (per 1000 inhab.)	11.84	11.84	11.82	11.69	11.56	11.29	11.29	11.31
GPs (per 1000 inhabitants)	0.96	0.96	0.99	1.02	1.02	1.04	1.05	1.05
Population >= 80 years (% of total)	5.49	5.43	5.36	5.30	5.25	5.23	5.22	5.24
Population < 80 years (% of total)	94.51	94.57	94.64	94.70	94.75	94.77	94.78	94.76
Inhabitants	11693	11851	12008	12149	12287	12407	12513	12599
MAW	0.01	0.01	0.05	0.30	0.52	0.69	0.94	0.97
PREP	0.01	0.01	0.04	0.16	0.23	0.33	0.45	0.46

Use of hospital services, patients >=80 years. Elasticities from fixed effects analyses.

VARIABLES	ACUTE				ELECTIVE
	ADMISSIONS		DAY STAYS		ADMISSIONS		DAY STAYS
	MEDICAL DEPARTMENTS	SURGICAL DEPARTMENTS	MEDICAL DEPART-MENTS	SURGICAL DEPARTMENTS	MEDICAL DEPARTMENTS	SURGICAL DEPARTMENTS	MEDICAL DEPARTMENTS	SURGICAL DEPARMENTS
Intercept	–1.50**	–0.63	1.94**	–2.31**	0.62	0.07	8.73**	–9.48**
(log) Nursing home places	0.03*	0.00	0.03**	–0.00	–0.01	–0.02*	0.13**	–0.10**
(log) GPs	0.03	0.00	0.01	–0.00	0.01	0.03*	0.10**	–0.03*
(log) Population >=80 years	0.56**	0.13**	0.08**	0.01	0.09**	0.13**	0.31**	0.03
(log) Population < 80 years	–	–	–	–	–	–	–	–
(log) Inhabitants	0.14**	0.06	–0.20**	0.23**	0.07	0.01	–0.93**	0.94**
MAW	–0.03**	0.00	–0.00*	0.01**	0.00	0.00	–0.01**	0.00
Fixed effects: Municipalities	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Fixed effects: Year	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Fixed effects: Month	yes	yes	yes	yes	yes	yes	yes	yes
Adj. R²	0.49	0.11	0.34	0.33	0.22	0.18	0.50	0.30

[i] */** = Significant at 0,05/0,01-level.

Demand for hospital services, patients <80 years. Elasticities from fixed effects analyses.

VARIABLES	ACUTE				ELECTIVE
	ADMISSIONS		DAY STAYS		ADMISSIONS		DAY STAYS
	MEDICAL DEPARTMENTS	SURGICAL DEPARTMENTS	MEDICAL DEPART-MENTS	SURGICAL DEPARTMENTS	MEDICAL DEPART-MENTS	SURGICAL DEPARTMENTS	MEDICAL DEPARTMENTS	SURGICAL DEPART-MENTS
Intercept	10.02**	–37.19**	19.37**	7.73**	–22.84**	33.17**	5.07*	–15.36**
(log) Nursing home places	0.06**	–0.17**	0.07**	0.07**	–0.02	0.17**	0.03**	–0.00
(log) GPs	0.05**	–0.06**	0.10**	0.01	–0.01	0.06**	0.14**	–0.09**
(log) Population >=80 years	–	–	–	–	–	–	–	–
(log) Population < 80 years	–1.43**	6.38**	–2.37**	–2.81**	4.98**	–4.49**	2.40**	2.20**
(log) Inhabitants	–0.18**	0.92**	0.83**	0.54**	0.08	–1.18**	1.65**	0.65**
MAW	–0.01**	–0.00	–0.01**	0.01**	0.00	0.01*	0.02**	0.01**
Fixed effects: Municipalities	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Fixed effects: Year	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Fixed effects: Month	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Adj. R²	0.55	0.29	0.54	0.67	0.55	0.55	0.77	0.72

[i] */** = Significant at 0,05/0,01-level.

Demand for acute hospital admissions at internal medicine departments. Elasticities from fixed effects analyses.

VARIABLES	ADMISSIONS
VARIABLES	≥80 YEARS	<80 YEARS
Intercept	–1.62**	9.20**
(log) Nursing home places	0.03*	0.06**
(log) GPs	0.03**	0.05**
(log) Population > = 80 years	0.55	–
(log) Population < 80 years	–	–1.25**
(log) Inhabitants	0.15**	–0.18**
MAW	–0.02**	0.01
MAW * PREP	–0.01*	–0.02**
Fixed effects: Municipalities	Yes	Yes
Fixed effects: Year	Yes	Yes
Fixed effects: Month	yes	yes
Adj. R²	0.49	0.55