Browsing by Subject "Delayed discharge"

This thesis studies the effects of delayed discharge fees in Finland. Excessive lengths of hospital stays are a significant source of inefficacy in the health care system. Delayed discharge occurs when a patient who is medically fit to leave the hospital cannot do so for non-medical reasons. In Finland, several hospital districts have implemented financial fees to curb delayed discharges. As the fees were not adopted simultaneously everywhere, it provides a desirable research setting. I use a staggered difference-in-difference design to study how the delayed discharge fees reduce the length of hospital stays and the probability of urgent hospital readmission using patient-level data. I presume that the fees work as an incentive to increase the supply of post-acute care beds. Hence, the implementation of delayed discharge fees would lead to fewer delays and consequently shorter hospital days and early access to post-acute care. Previous literature suggests that there exists an inverse correlation between delayed discharges and the availability of post-acute care beds. In addition, there is evidence that health care providers react to financial incentives. However, the existing literature documents contradicting results on the effects of the delayed discharge fees. The chosen identification strategy does not yield valid results when using the length of stay as a dependent variable. My results suggest that the parallel trends assumption does not hold. The pre-treatment trends persist even after controlling for group-specific variables. I find that the delayed discharge fees reduce the probability of readmission for elderly hip-fracture patients. The effect is modest in size but increases over time. After six years from the implementation, the effect of the fees is -0.059 per cent. The classical two-period difference-in-difference model concludes that the decrease in probability associated with the delayed discharge fees is - 0.018 per cent. Although significant, the reduction in probability is small. Hence strong conclusions should be avoided. My results suggest that delayed discharge fees could have positive implications on patients’ health but that their effects be further studied.