Essays on long-term care and hospital care

This thesis consists of four empirical essays, contributing to the understanding of key policy issues related to the maximisation of the efficiency of health care provision. Two policy areas are considered and the English NHS is used as a case study throughout. Chapters 2-4 contribute to a growing literature around the interface between acute hospital care and long-term care. This is closely related to the debate around integrating care.

Chapter 2 evaluates the impact of long-term care supply on the discharge destination and hospital length of stay of hip fracture and stroke patients. The results indicate hospital stays are shorter for hip fracture patients when nearby care-home bed supply is high. No effect of care-home beds is found for the length of stay of stroke patients or the discharge destination of either patient group.

Chapter 3 models delayed discharges from hospital across local government areas (Local Authorities). The findings suggest there are fewer delays in Local Authorities with more care-home beds. Further, higher care-home bed supply and lower population in neighbouring Local Authorities also leads to fewer delayed discharges in the local area. Chapter 4 evaluates the impact of hospital characteristics on delayed hospital discharges. The results indicate that
hospitals with more autonomy and a proven track record of good performance incur fewer delayed discharges.

The second policy area considered is the use of financial incentives to encourage a shift in patient care expected to improve efficiency. Chapter 5 evaluates a policy of paying hospitals a higher rate for same day discharges than overnight stays when treating specific conditions. The results indicate some positive effects from the policy introduced. Same day discharge rates are higher for eight out of 32 conditions. Considerable heterogeneity in response is also observed, some of which might be driven by features of the conditions.