title: Interdependency between social care and hospital care: the case of hospital length of stay.
abstract: BACKGROUND
  Poor co-ordination and collaboration have been identified by many governments as a major and growing weakness of their health care systems. Better integrated care for the elderly individuals is one field of particular importance. In this study, we ask to what extent local authorities' social care services create cost externalities by prolonging hospital length of stay (LOS) because of inadequate service capacity and/or service quality.
  
  
  METHODS
  The data set is constructed by merging in-patient data from the Norwegian Patient Register with Statistics Norway's local authority variables for the period from 2007 to 2009. The sample includes ∼386 000 observations of in-patients aged ≥ 67 years. Using the quantile regression (QR) technique, we analyse the impact of social care services along the entire distribution of LOS. The QR estimates are compared with ordinary least square estimates (OLS). Patient variables in the analyses include age, gender and case-mix variables. Hospital and time-fixed effects are also controlled for variables.
  
  
  RESULTS
  More resources to the social care services give shorter LOS, and the QR analysis shows that resources matter more for patients in the long tail of the distribution compared with those in the lower quantiles. LOS is longer for patients with change of residence after discharge from hospital compared with those patients that do not change residence.
  
  
  CONCLUSIONS
  Increased supply of social care services contributes to a reduction in aggregate societal costs of treatment and nursing of elderly patients by shortening comparatively costly hospital LOS.
authors.affiliation: Stein Rokkan Centre for Social Studies and Health Economics Bergen (HEB), Bergen, Norway.
authors.forename: Tor Helge
authors.initials: TH
authors.lastname: Holmås
authors.forename: Muhammad Kamrul
authors.initials: MK
authors.lastname: Islam
authors.forename: Egil
authors.initials: E
authors.lastname: Kjerstad
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009664:Norway / Q000453:epidemiology; D012737:Sex Factors; D012947:Social Work / Q000592:standards