Background
The Norwegian Coordination Reform (CR) in 2012 introduced new economic incentives aimed at weaknesses in the way primary /social care and specialist care interacted. This paper studies the association of a new co-payment scheme on 30-day survival probability for chronic and multimorbidity patients. We also analyse whether or not admission types - planned or emergency - matters for survival rates. Furthermore, we examine the importance of patient pathways. Several different pathways are possible, depending on where patients came from before being admitted to hospital and their destination after discharge from hospital.
Methods
The study uses data from three different registers for the period 2010 to 2013. We consider 30 common chronic conditions for which administrative data are available (n=563,096). We look at three mutually exclusive pathways, pathways that are the important ones in terms of the number of patients dependent on co-operation and co-ordination between health care providers. Using a quasi-experimental design—the difference-in-differences approach—we estimate the associations between the co-payment scheme and survival probability by admission type and by patient pathway.
Results
We find that the change in survival probability is significant and positively associated with the co-payment scheme for emergency admissions, but no significant association is found for planned admissions. A positive and significant relationship is found for emergency patients for two specific pathways—patients coming from home and discharged to social care institutions after hospitalization, and patients coming from home and discharged to other health care institutions after hospitalization. For planned admissions, the survival probability is significantly and negatively associated for patients coming from home and later discharged to social care institutions. Multimorbidity subgroup analysis shows that the negative association with survival is significant for only planned admissions for the patients coming from home and later discharged to home after hospitalization.
Conclusion
We conclude that the 30-day survival probability is positively associated with the new economic incentives but the result depends on admission type, patient pathway and multimorbidity status. Without modelling admission type, pathway and multimorbidity explicitly, one may overlook important relationships associated with the economic incentives. Future policy evaluations in any pertinent context should envisage these aspects.