Back to Search
Start Over
Do we care about high-cost patients? Estimating the savings on health spending by integrated care.
- Source :
-
The European journal of health economics : HEPAC : health economics in prevention and care [Eur J Health Econ] 2022 Nov; Vol. 23 (8), pp. 1297-1308. Date of Electronic Publication: 2022 Jan 25. - Publication Year :
- 2022
-
Abstract
- A recent integrated health care initiative in Belgium supports 12 regional pilot projects scattered across the country and representing 21% of the population. As in shared savings programs, part of the estimated savings in health spending are paid out to the projects to reinvest in new actions. Short-term savings are expected in particular from cost reductions among high-cost patients. We estimate the effect of the projects on spending using a difference-in-difference model. The sensitivity of the results to the right-skewness of spending is commonly addressed by removing or top-coding high-cost cases. However, this leads to an underestimation of realized savings at the top end of the distribution, therefore, lowering incentives for cost reduction. We show that this trade-off can be weakened by an alternative approach in which cost categories that fall out of the scope of the projects' interventions are excluded from the dependent variable. We find that this approach leads to improvements in precision and model fit that are of the same magnitude as excluding high-cost cases altogether. At the same time, it sharpens the incentives for cost reduction because the model better reflects the costs that projects can affect.<br /> (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Subjects :
- Belgium
Cost Savings
Humans
United States
Delivery of Health Care, Integrated
Income
Subjects
Details
- Language :
- English
- ISSN :
- 1618-7601
- Volume :
- 23
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The European journal of health economics : HEPAC : health economics in prevention and care
- Publication Type :
- Academic Journal
- Accession number :
- 35076807
- Full Text :
- https://doi.org/10.1007/s10198-022-01431-3