A Ana Moura está a terminar o doutoramento e apresenta-se no job market nesta temporada com um estudo muito pertinente sobre cuidados continuados em Portugal. Fique a conhecer os resultados do mais recente trabalho da Ana (job market paper).
Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal
Excessive length of hospital stay is one of the leading sources of inefficiency in healthcare. One possible cause of excessive length of hospital stay is lack of alternative care arrangements following a hospitalization. When a patient is medically fit to be discharged but requires some form of support outside the hospital (a short stay at a nursing home facility or home help), which is not readily available, the patient cannot be safely discharged. The patient stays at the hospital for a longer period until a safe discharge is possible –a phenomenon called bed-blocking.
My job market paper investigates whether the entry of subsidized nursing homes (NH) and teams providing home care (HC) reduces hospital bed-blocking. I use data on the universe of inpatient admissions in Portugal between 2000-2015. My empirical approach compares the length of stay of individuals at increased risk of bed-blocking and the length of stay of regular patients, before and after the entry of the first NH and HC team in their region of residence. This design exploits two distinct sources of variation. First, it exploits variation across regions and time in the availability of NH and HC teams, originating from the staggered implementation of a policy reform. Second, it exploits variation between patients in their propensity to bed-block, due to the presence of social needs (e.g. lack of family support).
I find that the entry of HC teams in a region reduces the length of stay of individuals at increased risk of bed-blocking by 4 days relative to regular patients. Reductions in length of stay upon the entry of NH occur only for patients with high care needs. Importantly, these reductions in length of stay are not accompanied by reductions in treatment intensity or by increases in the probability of a readmission. Finally, the beds freed up by reducing bed-blocking do not remain empty: there is an increase in the number of programmed admissions following the entry of HC teams.
These results yield two important policy implications. First, NH and HC teams target different patients and should be used as complements. Second, HC teams are more effective than NH at reducing bed-blocking because the average bed-blocker is not sick enough to need a NH. Taken together, my findings provide insights for organizing care delivery to patients with a complex combination of health and social needs.
Ana Moura
PhD Candidate, Economics Tilburg University
Website: anamoura.site
Twitter: @ana_c_moura
Link to paper: anamoura.site/files/MouraJMP.pdf
