Outcome, Use of Resources and Their Relationship in the Treatment of AMI, Stroke and Hip Fracture at European Hospitals

• Published in: Health economics 2015-12, Vol.24 (S2), p.116-139
• Main Authors: Häkkinen, Unto, Rosenqvist, Gunnar, Iversen, Tor, Rehnberg, Clas, Seppälä, Timo T.
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; Comparative studies; cost-quality trade-off; Costs and Cost Analysis; Europe - epidemiology; Fractured hips; Fractures; Health economics; Health Resources - utilization; Heart attacks; hip fracture; Hip Fractures - mortality; Hip Fractures - surgery; Hip joint; Horizontal integration; hospital care; Hospitals; Hospitals - statistics & numerical data; Humans; Income; Infarction; Integrated care; Medical treatment; Medicin och hälsovetenskap; Models, Econometric; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Outcome Assessment (Health Care); Patients; Quality Indicators, Health Care; Quality of care; Random effects; Regional variations; Stroke; Stroke - mortality; Stroke - therapy; survival; Survival analysis; use of resources
• ISSN: 1057-9230; 1099-1050; 1099-1050
• DOI: 10.1002/hec.3270

The aim of the present study was to compare the quality (survival), use of resources and their relationship in the treatment of three major conditions (acute myocardial infarction (AMI), stroke and hip fracture), in hospitals in five European countries (Finland, Hungary, Italy, Norway and Sweden). The comparison of quality and use of resources was based on hospital‐level random effects models estimated from patient‐level data. After examining quality and use of resources separately, we analysed whether a cost–quality trade‐off existed between the hospitals. Our results showed notable differences between hospitals and countries in both survival and use of resources. Some evidence would support increasing the horizontal integration: higher degrees of concentration of regional AMI care were associated with lower use of resources. A positive relation between cost and quality in the care of AMI patients existed in Hungary and Finland. In the care of stroke and hip fracture, we found no evidence of a cost–quality trade‐off. Thus, the cost–quality association was inconsistent and prevailed for certain treatments or patient groups, but not in all countries. Copyright © 2015 John Wiley & Sons, Ltd.