Long Term Care and Hospital Length of Stay for Elderly Patients

Posted: 12 Jun 2007

See all articles by Hilde Luras

Hilde Luras

Akershus University Hospital; Akershus University Hospital

Tor Helge Holmas

Foundation for Research in Economics and Business Administration (SNF)

Egil Kjerstad

UNI Rokkan Centre

Frode Kristiansen

Foundation for Research in Economics and Business Administration (SNF)

Abstract

The proportion of elderly in the population is increasing and old patients' bed occupancy rate in hospitals increase as a fraction of total bed occupancy. Because old patients on average are frailer than other age groups their length of stay (LOS) at hospitals is longer than average. In this paper we ask whether frailty and the need of a more comprehensive hospital treatment are the only explanation behind a comparatively long LOS for elderly patients.

In Norway, the organisation of primary health care and long time care (both institutional and home based long term care) is the responsibility of the municipalities, which is the lowest governmental level, while the central government is responsible for the public hospitals. Hence, both when an old patient is hospitalised and when he or she leaves the hospital the medical and care responsibility is carried over to another governmental level. It then follows that a smooth transfer between the two providers requires coordination and cooperation. But it also follows that the capacity and the organisation of long term care influence on the hospitals activity (and vice versa). Hence, within health care for the elderly there may be conflicting interests between providers of hospital services and providers of care services but also scope for cooperation. This interdependence between different types of health care providers for the elderly is almost universal, at least in USA, UK and Northern Europe.

We study whether the organisation and use of resources at hospital level influence LOS for the elderly, but also whether resources spent by providers of long term care services are of significance. In accordance we question whether formal contracts and certain coordination arrangement between hospitals and providers of long term care services matters. According to our analysis, increased pressure on long term care providers increase hospital LOS for patients aged 80 and above, but we also find that hospitals where a large share of total activity is at outpatient clinics have longer LOS than hospitals with more inpatient activity. The most interesting finding however, is the effect of the hospital's location; i.e. patients from rural areas without a hospital located in the municipality have shorter LOS than patients from central municipalities. Even if the effects are rather small, high nursing home coverage, high staffing ratio at hospitals and the existence of coordinating effort between hospitals and care services providers significantly reduces LOS. The last effect is only prevailing for patients admitted from their home and discharged to an institution after hospitalisation. We conclude that hospital LOS for elderly patients strongly depend on the interaction with the long term care services and the organisation and resources utilized in this sector. The results points to the importance of giving hospitals and care service providers stronger incentives to cooperate and coordinate their supply of services towards elderly patients than is the case at present, and also to see the organisation and financing of hospitals and long term care services in connection.

Keywords: length of stay, hospital care, long term care

JEL Classification: I11, I18

Suggested Citation

Luras, Hilde and Luras, Hilde and Holmas, Tor Helge and Kjerstad, Egil and Kristiansen, Frode, Long Term Care and Hospital Length of Stay for Elderly Patients. iHEA 2007 6th World Congress: Explorations in Health Economics Paper, Available at SSRN: https://ssrn.com/abstract=993309

Hilde Luras (Contact Author)

Akershus University Hospital ( email )

Oslo, N-0317
Norway

Akershus University Hospital ( email )

Oslo, N-0317
Norway

Tor Helge Holmas

Foundation for Research in Economics and Business Administration (SNF) ( email )

Breiviksveien 40
Bergen, N-5045
Norway

Egil Kjerstad

UNI Rokkan Centre ( email )

Nygårdsgt. 5
Bergen, N-5020
Norway

Frode Kristiansen

Foundation for Research in Economics and Business Administration (SNF) ( email )

Breiviksveien 40
Bergen, N-5045
Norway

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