title: The effect of activity-based financing on hospital length of stay for elderly patients suffering from heart diseases in Norway.
abstract: BACKGROUND
  Whether activity-based financing of hospitals creates incentives to treat more patients and to reduce the length of each hospital stay is an empirical question that needs investigation. This paper examines how the level of the activity-based component in the financing system of Norwegian hospitals influences the average length of hospital stays for elderly patients suffering from ischemic heart diseases. During the study period, the activity-based component changed several times due to political decisions at the national level.
  
  
  METHODS
  The repeated cross-section data were extracted from the Norwegian Patient Register in the period from 2000 to 2007, and included patients with angina pectoris, congestive heart failure, and myocardial infarction. Data were analysed with a log-linear regression model at the individual level.
  
  
  RESULTS
  The results show a significant, negative association between the level of activity-based financing and length of hospital stays for elderly patients who were suffering from ischemic heart diseases. The effect is small, but an increase of 10 percentage points in the activity-based component reduced the average length of each hospital stay by 1.28%.
  
  
  CONCLUSIONS
  In a combined financing system such as the one prevailing in Norway, hospitals appear to respond to economic incentives, but the effect of their responses on inpatient cost is relatively meagre. Our results indicate that hospitals still need to discuss guidelines for reducing hospitalisation costs and for increasing hospital activity in terms of number of patients and efficiency.
authors: Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway. jun.yin@ahus.no
authors: Jun
authors: J
authors: Yin
authors: Hilde
authors: H
authors: Lurås
authors: Terje P
authors: TP
authors: Hagen
authors: Fredrik A
authors: FA
authors: Dahl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000628:therapy*; D002391:Catchment Area, Health / Q000191:economics / Q000706:statistics & numerical data; D002497:Centralized Hospital Services / Q000191:economics; D003430:Cross-Sectional Studies; D005260:Female; D005377:Financial Management, Hospital / Q000379:methods* / Q000592:standards; D006331:Heart Diseases / Q000628:therapy*; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009664:Norway; D010360:Patient Transfer; D012041:Regional Medical Programs; D012042:Registries; D012044:Regression Analysis
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