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Demand, selection and patient outcomes in German acute care hospitals
Author(s) -
Schwierz Christoph,
Augurzky Boris,
Focke Axel,
Wasem Jürgen
Publication year - 2012
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.1706
Subject(s) - unobservable , german , affect (linguistics) , workload , medicine , volatility (finance) , emergency department , medical emergency , emergency medicine , economics , psychology , nursing , econometrics , management , archaeology , communication , history
SUMMARY This paper examines the effects of variation in unexpected demand on patient outcomes in acute care German hospitals. Naturally, an unexpected surge in demand may negatively affect the quality of care and thus patient outcomes, such as in‐hospital mortality. We estimate models explaining patient outcomes depending on demand, unobservable patient selection and seasonal factors, as well as patient‐specific risk factors and unobservable hospital and department fixed‐effects. The main message of this analysis is that hospitals are well prepared to deal with this unexpected volatility in demand, as by and large it does not negatively affect patient outcomes. Hospitals seem to deal with high unexpected workload by steering the patients' length of stay relating to their severity of illness. Elective patients are discharged earlier, while discharges of high‐risk emergency patients are postponed. Copyright © 2011 John Wiley & Sons, Ltd.