title: The Great Recession in Portugal: impact on hospital care use.
abstract: The Great Recession started in Portugal in 2009, coupled with severe austerity. This study examines its impact on hospital care utilization, interpreted as caused by demand-side effects (related to variations in population income and health) and supply-side effects (related to hospitals' tighter budgets and reduced capacity). The database included all in-patient stays at all Portuguese NHS hospitals over the 2001-2012 period (n=17.7 millions). We analyzed changes in discharge rates, casemix index, and length of stay (LOS), using a before-after methodology. We additionally measured the association of health care indicators to unemployment. A 3.2% higher rate of discharges was observed after 2009. Urgent stays increased by 2.5%, while elective in-patient stays decreased by 1.4% after 2011. The LOS was 2.8% shorter after the crisis onset, essentially driven by the 4.5% decrease among non-elective stays. A one percentage point increase in unemployment rate was associated to a 0.4% increase in total volume, a 2.3% decrease in day cases, and a 0.1% decrease in LOS. The increase in total and urgent cases may reflect delayed out-patient care and health deterioration; the reduced volume of elective stays possibly signal a reduced capacity; finally, the shorter stays may indicate either efficiency-enhancing measures or reduced quality.
authors.affiliation: Escola Nacional de Saúde Pública (Universidade Nova de Lisboa), Avenida Padre Cruz, 1600-5605 Lisbon, Portugal. Electronic address: jperelman@ensp.unl.pt.
authors.forename: Julian
authors.initials: J
authors.lastname: Perelman
authors.affiliation: Banco de Portugal, Rua do Comércio 148, 1100-150 Lisbon, Portugal; Nova School of Business and Economics (Universidade Nova de Lisboa) , Campus de Campolide, 1099-032 Lisbon, Portugal. Electronic address: sfelix@novasbe.pt.
authors.forename: Sónia
authors.initials: S
authors.lastname: Felix
authors.affiliation: Escola Nacional de Saúde Pública (Universidade Nova de Lisboa), Avenida Padre Cruz, 1600-5605 Lisbon, Portugal. Electronic address: RuiSantana@ensp.unl.pt.
authors.forename: Rui
authors.initials: R
authors.lastname: Santana
mesh_terms: D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D057172:Economic Recession; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D009313:National Health Programs; D011174:Portugal
keywords: Austerity; Healthcare use; Portugal; Recession