title: Outcome, Use of Resources and Their Relationship in the Treatment of AMI, Stroke and Hip Fracture at European Hospitals.
abstract: The aim of the present study was to compare the quality (survival), use of resources and their relationship in the treatment of three major conditions (acute myocardial infarction (AMI), stroke and hip fracture), in hospitals in five European countries (Finland, Hungary, Italy, Norway and Sweden). The comparison of quality and use of resources was based on hospital-level random effects models estimated from patient-level data. After examining quality and use of resources separately, we analysed whether a cost-quality trade-off existed between the hospitals. Our results showed notable differences between hospitals and countries in both survival and use of resources. Some evidence would support increasing the horizontal integration: higher degrees of concentration of regional AMI care were associated with lower use of resources. A positive relation between cost and quality in the care of AMI patients existed in Hungary and Finland. In the care of stroke and hip fracture, we found no evidence of a cost-quality trade-off. Thus, the cost-quality association was inconsistent and prevailed for certain treatments or patient groups, but not in all countries.
authors.affiliation: Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
authors.affiliation: Hanken School of Economics, Helsinki, Finland.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Rosenqvist
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
authors.forename: Tor
authors.initials: T
authors.lastname: Iversen
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Clas
authors.initials: C
authors.lastname: Rehnberg
authors.affiliation: Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Timo T
authors.initials: TT
authors.lastname: Seppälä
mesh_terms: D003365:Costs and Cost Analysis; D005060:Europe / Q000453:epidemiology; D006295:Health Resources / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; 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-quality trade-off; hip fracture; hospital care; stroke; survival; use of resources