TY - JOUR
T1 - The Great Recession in Portugal
T2 - impact on hospital care use
AU - Perelman, Julian
AU - Felíx, Sónia Manuela Castro
AU - Santana, Rui
N1 - PMID: 25583679
Scopus: 84923403035
WOS: 000352245700008
PY - 2015/3/1
Y1 - 2015/3/1
N2 - The Great Recession started in Portugal in 2009, coupled with severe austerity. This study examines its impact on hospital care utilization, interpreted as caused by demand-side effects (related to variations in population income and health) and supply-side effects (related to hospitals' tighter budgets and reduced capacity).The database included all in-patient stays at all Portuguese NHS hospitals over the 2001-2012 period (n= 17.7 millions). We analyzed changes in discharge rates, casemix index, and length of stay (LOS), using a before-after methodology. We additionally measured the association of health care indicators to unemployment.A 3.2% higher rate of discharges was observed after 2009. Urgent stays increased by 2.5%, while elective in-patient stays decreased by 1.4% after 2011. The LOS was 2.8% shorter after the crisis onset, essentially driven by the 4.5% decrease among non-elective stays. A one percentage point increase in unemployment rate was associated to a 0.4% increase in total volume, a 2.3% decrease in day cases, and a 0.1% decrease in LOS.The increase in total and urgent cases may reflect delayed out-patient care and health deterioration; the reduced volume of elective stays possibly signal a reduced capacity; finally, the shorter stays may indicate either efficiency-enhancing measures or reduced quality.
AB - The Great Recession started in Portugal in 2009, coupled with severe austerity. This study examines its impact on hospital care utilization, interpreted as caused by demand-side effects (related to variations in population income and health) and supply-side effects (related to hospitals' tighter budgets and reduced capacity).The database included all in-patient stays at all Portuguese NHS hospitals over the 2001-2012 period (n= 17.7 millions). We analyzed changes in discharge rates, casemix index, and length of stay (LOS), using a before-after methodology. We additionally measured the association of health care indicators to unemployment.A 3.2% higher rate of discharges was observed after 2009. Urgent stays increased by 2.5%, while elective in-patient stays decreased by 1.4% after 2011. The LOS was 2.8% shorter after the crisis onset, essentially driven by the 4.5% decrease among non-elective stays. A one percentage point increase in unemployment rate was associated to a 0.4% increase in total volume, a 2.3% decrease in day cases, and a 0.1% decrease in LOS.The increase in total and urgent cases may reflect delayed out-patient care and health deterioration; the reduced volume of elective stays possibly signal a reduced capacity; finally, the shorter stays may indicate either efficiency-enhancing measures or reduced quality.
KW - Austerity
KW - Healthcare use
KW - Portugal
KW - Recession
UR - http://www.scopus.com/inward/record.url?scp=84923403035&partnerID=8YFLogxK
U2 - 10.1016/j.healthpol.2014.12.015
DO - 10.1016/j.healthpol.2014.12.015
M3 - Article
C2 - 25583679
AN - SCOPUS:84923403035
SN - 0168-8510
VL - 119
SP - 307
EP - 315
JO - Health policy (Amsterdam, Netherlands)
JF - Health policy (Amsterdam, Netherlands)
IS - 3
ER -