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The influence of social deprivation on length of hospitalisation

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Abstract

The implementation of activity-based payment system named T2A—tarification à l’activité—in 2004 profoundly modified the financing of French hospitals. Presently applied to activities concerning medicine, surgery and obstetrics, the pricing for these activities was developed using the National Costs Study. The considerable differences observed between costs in the private sector and those in the public sector are in part justified, by the latter, by caring for patients with social deprivation. The goal of this study is to measure the influence of social deprivation on the length of hospitalisation. A survey on inpatient social deprivation was carried out from November to December 2008 by the French Ministry of Health (Department of Research, Study, Evaluation and Statistics—DREES, and technical agency of Hospital information—ATIH). Four dimensions of social deprivation were taken into consideration after a previous qualitative study: social isolation, quality of housing, level of income and access to rights. The sample is based on 27 hospitals, including public and private (for-profit and not-for-profit), representing 57,175 stays, 6,800 of which were patients with social deprivation. After multivariate analyses adjusted for age, severity of illness and DRG, we found that there was a longer length of stay for inpatients with social deprivation (+16%), and in particular for patients living in social isolation (+17%) and for patients with inadequate housing (+17%). The impact of low income on the length of stay is less important. However, low income associated with inadequate housing significantly increases lengths of stay (+24%).

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Notes

  1. Diagnosis-Related Groups.

  2. This chapter corresponds to factors influencing the state of health and reasons for having recourse to healthcare services.

  3. The version of the GHM classification is the V10c.

  4. Source: comprehensive 2008 PMSI (ATIH).

  5. The case mix corresponds to the range of the facilities’ activities described through GHMs (Diagnosis-Related Groups).

  6. This result is obtained when “financially poor” is mixed with “homeless,” which seems obvious, but also when “financially poor” is mixed with “inadequate housing,” whereas when not combined, these two variables do not appear to be significant.

  7. We choose to control for severity by using GHM classification, age and gender, but we choose not to use additional information such as comorbidities because when this information is not relevant to have a better tariff, some hospital of our sample do not use it.

References

  1. Aballea, P., Bras, P.L., Seydoux, S.: Mission d’appui sur la convergence tarifaire public-privé. La documentation française, rapport IGAS No. 2006009 (2006)

  2. Blanchard, N., Pichetti, S., Raynaud, D.: 2ème rapport du comité d’évaluation de la tarification à l’activité. DREES, Documents de travail, Série Études et Recherche No. 94 (2009)

  3. Bonastre, J., Le Vaillant, M., De Pouvourville, G.: The impact of research on hospital costs of care: an empirical study. Health Econ. 20, 73–87 (2011)

    Article  PubMed  Google Scholar 

  4. Bréchat, C., et al.: Hôpitaux publics, T2A et handicap social. Gestion Hospitalières 457, 403–440 (2006)

    Google Scholar 

  5. Cash, R., Dupilet, C.: La réactivité des établissements de santé aux incitations tarifaires. DREES, Dossier Solidarité Santé (2011)

  6. Closon, M.C., Maes, N., Duchaine, A.: Impact des facteurs sociaux sur les durées de séjours dans les hôpitaux. Rapport du centre d’étude interdisciplinaire en économie de la santé, Bruxelles (1998)

  7. Epstein, A.M., Stern, R.S., Weissman, J.S.: Do the poor cost more? A multihospital study of patients’ socioeconomic status and use of hospital resources. New Engl. J. Med. 322(16), 1122–1128 (1990)

    Google Scholar 

  8. Greene, W.H.: Econometric Analysis, 4th edn. Prentice Hall, New Jersey (2000)

    Google Scholar 

  9. Holstein, J., et al.: Lien précarité—durée et complexité des séjours hospitaliers en secteur de court séjour. Revue d’Épidémiologie et de Santé Publique 57, 205–211 (2009)

    Google Scholar 

  10. Lebas, J.: A l’épreuve de la précarité, une certaine idée de l’hôpital. La documentation française, Feb 1998

  11. Maric, M., Grégoire, E, Leporcher, L.: La prise en charge des populations dites précaires dans les établissements de soins. Document de travail DREES, série études et recherches, no. 81 (2008)

  12. Mathy, C., Bensadon, M.: Le surcoût de l’hospitalisation des patients précaires. Journal D’économie Médicale, 20(5), 263–278 (2002)

    Google Scholar 

  13. Or, Z., Renaud, T., Com-Ruelle, L.: Les écarts des coûts hospitaliers sont-ils justifiables? Rélexions sur une convergence tarifaire entre les secteurs public et privé en France. Document de travail no. 25, IRDES, May 2009

  14. Or, Z.: Activity based payment in France. Euro Obs. 11(4), 5–6, winter (2009)

  15. Organisation Mondiale de la Santé. Classification statistique internationale des maladies et des problèmes de santé connexes. Dixième Révision.CIM-10. Éditions 2008

  16. Perronnin, M., Sourty, M.-J.: Influence des caractéristiques sociales et environnementales sur la durée de séjour à l’hôpital. IRDES, Questions d’économie de la santé no. 71 (2003)

  17. Quantin, C. et al.: Modélisation de la distribution des durées de séjour et des coûts dans deux groupes homogènes de malades d’hématologie et de pneumologie: caractérisation clinique des patients de longue durée et de coût élevé. Revue d’Épidémiologie et de Santé Publique, 45, 117–130 (1997)

  18. Rice, N., Jones, A.: Multilevel models and health economics. Health Econ. 6, 561–575 (1997)

    Article  PubMed  CAS  Google Scholar 

  19. Schleifer, A.: A theory of yardstick competition. Rand J. Econ. 16(3), 319–328 (1985)

    Article  Google Scholar 

  20. Singh, C.H., Ladusingh, L.: Inpatient length of stay: a finite mixture modelling analysis. Eur. J. Health Econ. 11, 119–126 (2010)

    Article  PubMed  Google Scholar 

  21. Wresinski, J.: Grande pauvreté et précarité économique et sociale. Report adopted by the French Economic and Social Council. J. Off. (1987)

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Acknowledgments

We thank Alberto Holly and all participants of the 2010 Irdes workshop on applied health economics and policy evaluation for their comments and suggestions. We are also grateful to Renaud Legal, different reviewers by DREES for theirs comments, and the anonymous reviewers for their constructive comments and suggestions.

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Authors and Affiliations

  1. Department of Research, Study, Evaluation and Statistics (DREES) of the French Ministry of Health, 14 Avenue Duquesne, 75350, Paris 07 SP, France

    Engin Yilmaz & Denis Raynaud

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  1. Engin Yilmaz
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  2. Denis Raynaud
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Correspondence to Engin Yilmaz.

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Yilmaz, E., Raynaud, D. The influence of social deprivation on length of hospitalisation. Eur J Health Econ 14, 243–252 (2013). https://doi.org/10.1007/s10198-011-0365-4

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