title: Quality, cost, and their trade-off in treating AMI and stroke patients in European hospitals.
abstract: OBJECTIVE
  This study compared the cost and in-hospital mortality of hospital care for two major diseases, acute myocardial infarction (AMI) and stroke, by pooling patient-level data from five European countries (Finland, France, Germany, Spain, and Sweden). We examined whether a cost-quality trade-off existed in these countries by comparing hospital-level costs and survival rates, and whether hospitals which performed well in terms of cost or quality in treating one patient group (AMI) performed well also in treating the other patient group (stroke).
  
  
  METHODS
  A fixed-effect probit regression model for survival and the linear model for log costs were used to calculate indicators for hospital quality and cost, which were plotted against each other.
  
  
  RESULTS
  Both with AMI and stroke there were remarkable differences between hospitals and countries in (both crude and adjusted) rates of patients discharged alive. Swedish and French hospitals had lower mortality than hospitals in Germany, Finland and Spain in the care of AMI patients. However, a longer length of stay in Spanish and German hospitals may bias the results in the two countries. The Finnish hospitals seemed to have lower mortality than the other countries' hospitals in the care of stroke patients. There was no correlation at either the national or hospital level in the quality of treatment of these two diseases. We did not find a clear cost-quality trade-off. The only notable exception was Sweden, where the costs for AMI patients were higher in hospitals with the highest quality of care.
  
  
  CONCLUSIONS
  Countries should identify the best performing hospitals both in terms of cost and quality in order to learn from hospitals that demonstrate better practice. It is equally important to better understand the reasons behind the observed differences between hospitals in costs and quality.
authors.affiliation: National Institute for Health and Welfare, Centre for Health and Social Economics, Finland. Electronic address: unto.hakkinen@thl.fi.
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
authors.affiliation: National Institute for Health and Welfare, Centre for Health and Social Economics, Finland; Department of Finance and Statistics, Hanken school of Economics, Finland.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Rosenqvist
authors.affiliation: National Institute for Health and Welfare, Centre for Health and Social Economics, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Peltola
authors.affiliation: National Institute for Health and Welfare, Centre for Health and Social Economics, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Kapiainen
authors.affiliation: National Institute for Health and Welfare, Centre for Health and Social Economics, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Rättö
authors.affiliation: Epidemiology and Evaluation Department, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Cots
authors.affiliation: Department of Health Care Management, Technische Universität (TU) Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Geissler
authors.affiliation: Institute of Research and Information on Health Economics, France.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Or
authors.affiliation: National Board of Health and Welfare, Sweden.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Serdén
authors.affiliation: National Institute for Health and Welfare, Service System Research Unit, Helsinki, Finland.
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D017721:Hospital Costs / Q000458:organization & administration*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D020521:Stroke / Q000401:mortality / Q000628:therapy*
keywords: Acute myocardial infarction; Cost; Cost–quality trade-off; Hospital care; Quality; Stroke