Widening a Bottleneck: Towards a Better Patient Flow in Health Services : An analysis of utilization of specialized health services for diagnose-groups at the municipality level. Studied period from years 1999 to 2007
BACKGROUND: The coordination reform is currently a hot political topic. Part of the reform’s delivery arrangements is related to the expansion of municipal health services. This aims to relocate health services and increase the municipalities’ share of responsibility. Financial measures are also proposed to support the other policy arrangements. Before these policies are introduce, it is important to see if an expansion and relocation of health services to the municipalities reduce the use of specialized health services. It is also interesting to find evidence on how the use of specialized health services with regards to specific diagnose-groups varies in the presence of municipal supply of health care. OBJECTIVE: The main aim of this study is to predict if the coverage of municipal health care services might reduce or not the utilization of specialized health services at hospitals. That is, substitution or not substitution between the somatic level and municipal level of care. As a secondary objective, it intends to shed light on this with regards to different diagnose-groups to provide information on the potential effects of municipal copayment measures. METHOD: Panel data from 1999 to 2007 aggregated at the municipal ward level is used for two types of analyses: total and limited diagnose-group populations. To measure the utilization of specialized health services, the study uses hospital inpatient admissions categorized in 5 diagnose-groups. Proxies of needs and variables that express the municipal supply are used in an weighted least-squares analysis to predict the variation of utilization of specialized health services. RESULTS: Positive significant effects (1%, 5%) were present in the results concerning the coverage of municipal physicians. Negative but less significant effects (5%,10%), came from the other municipal supply side variables such as social and nursing care. The effects from the analyses vary across the different diagnose-groups. CONCLUSIONS: The coverage of physicians increases the utilization of specialized health services in many of the results, and therefore there is not substitution from this type of heath provision. In contrast, the social and nursing care and other municipal supply side variables appear to reduce slightly the use of specialized health services.