[go: up one dir, main page]

IDEAS home Printed from https://ideas.repec.org/p/idb/brikps/13701.html
   My bibliography  Save this paper

Are Long Hospitalizations Substituting Primary and Long-term Care?: Evidence from Brazil and Mexico

Author

Listed:
  • Aranco, Natalia
  • Bauhoff, Sebastian
  • Schwarz, Natalie Vanessa
  • Stampini, Marco
Abstract
Prolonged hospital stays, or hospital stays that are longer than medically necessary, are a major concern for patients, payers, and providers. We conceptualize and empirically estimate the prevalence and cost of prolonged stays among elderly hospital patients (65 years and older) in Brazil and Mexico. We develop a continuum-of-care conceptual framework based on prior literature and insights obtained through interviews and focus group discussions with experts from Mexico, Argentina, and Colombia. In this framework, hospitals are part of a wider system. This system involves both pre-admission and post-discharge medical and social care services. There are three main sources of prolonged stays: (i) lack of appropriate primary healthcare that leads to more complex admissions; (ii) hospital inefficiency; and (iii) lack of rehabilitation, social, and long-term care at discharge. We estimate the count and share of inappropriate hospital days due to prolonged stays overall and for each source. This estimation is based on administrative records on discharges from public sector hospitals in 2019. Our results show that hospital days due to prolonged stays account for approximately half of all hospital days. Although most of the inappropriate days can be attributed to hospital inefficiency, an important share is linked to the lack of rehabilitation, social, and long-term care. Lack of these services accounts for 12% of total hospital days in Brazil and 7% in Mexico. In a back-of-the-envelope calculation, we estimate that providing six weeks of long-term care services to address the care needs brought about by only thirteen causes of admission would generate annual net savings of approximately US$174 million in Brazil and US$45 million in Mexico.

Suggested Citation

  • Aranco, Natalia & Bauhoff, Sebastian & Schwarz, Natalie Vanessa & Stampini, Marco, 2024. "Are Long Hospitalizations Substituting Primary and Long-term Care?: Evidence from Brazil and Mexico," IDB Publications (Working Papers) 13701, Inter-American Development Bank.
  • Handle: RePEc:idb:brikps:13701
    DOI: http://dx.doi.org/10.18235/0013126
    as

    Download full text from publisher

    File URL: https://publications.iadb.org/publications/english/document/Are-Long-Hospitalizations-Substituting-Primary-and-Long-term-Care-Evidence-from-Brazil-and-Mexico.pdf
    Download Restriction: no

    File URL: https://libkey.io/http://dx.doi.org/10.18235/0013126?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Costa-Font, Joan & Jimenez-Martin, Sergi & Vilaplana, Cristina, 2018. "Does long-term care subsidization reduce hospital admissions and utilization?," Journal of Health Economics, Elsevier, vol. 58(C), pages 43-66.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Quitterie Roquebert & Jonathan Sicsic & Thomas Rapp, 2021. "Health measures and long-term care use in the European frail population," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(3), pages 405-423, April.
    2. Bakx, Pieter & Wouterse, Bram & van Doorslaer, Eddy & Wong, Albert, 2020. "Better off at home? Effects of nursing home eligibility on costs, hospitalizations and survival," Journal of Health Economics, Elsevier, vol. 73(C).
    3. Moura, Ana, 2022. "Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal," Journal of Health Economics, Elsevier, vol. 84(C).
    4. Costa-Font, Joan & Jiménez-Martín, Sergi & Vilaplana-Prieto, Cristina, 2022. "Do Public Caregiving Subsidies and Supports affect the Provision of Care and Transfers?," Journal of Health Economics, Elsevier, vol. 84(C).
    5. Joan Costa-Font & Valentina Zigante, 2020. "Building ‘implicit partnerships’? Financial long-term care entitlements in Europe," Policy Sciences, Springer;Society of Policy Sciences, vol. 53(4), pages 697-712, December.
    6. Guangbo Ma & Kun Xu, 2022. "Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health," IJERPH, MDPI, vol. 20(1), pages 1-20, December.
    7. Miao Guo & Yang Li & Minghao Wu & Terence C. Cheng, 2024. "Services and Cash: How Long-term Care Insurance Benefit Design Affects Household Behavior in China," Papers 2024-13, Centre for Health Economics, Monash University.
    8. Hollingsworth, Bruce & Ohinata, Asako & Picchio, Matteo & Walker, Ian, 2022. "Does It Matter Who Cares for You? The Effect of Substituting Informal with Formal Personal Care on the Care Recipients' Health," IZA Discussion Papers 15457, Institute of Labor Economics (IZA).
    9. Costa-Font, Joan & Zigante, Valentina, 2020. "Building ‘implicit partnerships’? Financial long-term care entitlements in Europe," LSE Research Online Documents on Economics 106099, London School of Economics and Political Science, LSE Library.
    10. Masaki Takahashi, 2023. "Insurance coverage, long-term care utilization, and health outcomes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(8), pages 1383-1397, November.
    11. Milovanska-Farrington, Stefani & Farrington, Stephen, 2019. "The effect of the cost of obstetric care on antenatal and postnatal healthcare utilization: Evidence from Armenia," Research in Economics, Elsevier, vol. 73(1), pages 72-84.
    12. Brendan Walsh & Seán Lyons & Samantha Smith & Maev‐Ann Wren & James Eighan & Edgar Morgenroth, 2020. "Does formal home care reduce inpatient length of stay?," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1620-1636, December.
    13. Florentino Felgueroso & Angel de la Fuente & José E. Boscá & Joan Costa i Font & Rafael Doménech & Javier Ferri & José I. García Pérez & Sergi Jiménez & Diego Rodríguez & Analía Viola, 2020. "Aspectos económicos de la crisis del Covid-19. Boletín de seguimiento nº2," Studies on the Spanish Economy eee2020-14, FEDEA.
    14. Coe, Norma B. & Goda, Gopi Shah & Van Houtven, Courtney Harold, 2023. "Family spillovers and long-term care insurance," Journal of Health Economics, Elsevier, vol. 90(C).
    15. Liu, Hong & Ma, Jinqiu & Zhao, Liqiu, 2023. "Public long-term care insurance and consumption of elderly households: Evidence from China," Journal of Health Economics, Elsevier, vol. 90(C).
    16. Caroline Bähler & Roland Rapold & Andri Signorell & Oliver Reich & Radoslaw Panczak & Eva Blozik, 2020. "Regional differences in healthcare costs at the end of life: an observational study using Swiss insurance claims data," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 65(6), pages 969-979, July.
    17. Chandoevwit, Worawan & Wasi, Nada, 2020. "Incorporating discrete choice experiments into policy decisions: Case of designing public long-term care insurance," Social Science & Medicine, Elsevier, vol. 258(C).
    18. Giuliano Masiero & Fabrizio Mazzonna & Michael Santarossa, 2022. "The effect of absolute versus relative temperature on health and the role of social care," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1228-1248, June.
    19. Walsh, Brendan & Wren, Maev-Ann & Smith, Samantha & Lyons, Seán & Eighan, James & Morgenroth, Edgar, 2019. "An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital," Research Series, Economic and Social Research Institute (ESRI), number RS91.
    20. Manuel Serrano-Alarcón & Helena Hernández-Pizarro & Guillem López i Casasnovas & Catia Nicodemo, 2021. "The effect of Long-Term Care (LTC) benefits on healthcare use," Working Papers 2021-12, FEDEA.

    More about this item

    Keywords

    Healthcare costs; prolonged hospitalizations; primary health care; long-term care; medical care; population aging; older persons; public policy; social care; rehabilitation care;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination
    • H55 - Public Economics - - National Government Expenditures and Related Policies - - - Social Security and Public Pensions
    • J18 - Labor and Demographic Economics - - Demographic Economics - - - Public Policy

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:idb:brikps:13701. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Felipe Herrera Library (email available below). General contact details of provider: https://edirc.repec.org/data/iadbbus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.