Elsevier

Health Policy

Volume 120, Issue 9, September 2016, Pages 1008-1016
Health Policy

Length of stay and readmission in lumbar intervertebral disc disorder inpatients by hospital characteristics and volumes

https://doi.org/10.1016/j.healthpol.2016.08.004Get rights and content

Highlights

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    National health insurance claim data used in our study.

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    Hospital volume had inverse association with length of stay.

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    Higher number of neurosurgeons, doctors, and nurses provided more effective management.

Abstract

In South Korea, lumbar intervertebral disc disorder (LIDD) patients are increasing in all age groups due to an aging population and changes in lifestyle, like sedentary, and there has been concern about reducing quality of care and increasing healthcare expenditure. Therefore, we aim to study the impact of hospital volume and hospital staffing, such as neurosurgeon or nurse, for length of stay or readmission in LIDD inpatients. We used health insurance claim data from 157 hospitals, consisting of 88,949 inpatient cases during 2010–2013. Multi-level models were analyzed to examine the association between LOS/readmission and both inpatient and hospital level variables. By the results, the average LOS was 10.85 days, and readmission within 30 days after discharge was 1063 (1.2%) cases. Higher hospital volume or number of neurosurgeons/ doctors showed inverse relation with LOS (per increases 100 cases = β: −0.0457, P-value < 0.0001; per increases 1 neurosurgeon = β: −0.3517, P-value < 0.0001; number of doctors per 100 beds = β: −0.1200, P-value < 0.0001). And, higher number of registered nurses (RNs) showed inverse relation with early readmission. In conclusion, higher volume or staffing showed positive relation with improving efficiency and quality in care of LIDD. Therefore, health policy makers should consider providing incentives or motivation to hospitals with higher volume or more superior hospital staffing for effective management of excessive healthcare expenditure or reducing quality of care.

Section snippets

Background

Lumbar intervertebral disc disorders (LIDD) are frequently encountered health problems [1]. LIDD, defined as functional and structural defects of the intervertebral disc from thoracic to sacral, may result from genetic, degenerative, or socioeconomic factors and induce back or leg pain, numbness and weakness [2], [3]. In South Korea, LIDD patients are increasing in all age groups due to an aging population and changes in lifestyle, like sedentary [4].

Such increases were accelerated by

Study population

There were approximately 1730 hospitals including 40 public hospitals during 2010–2013 in Korea. Although it would have been ideal had we been able to use data from all hospitals in South Korea, there were some difficulties in accessing patient information due to ethical issues and it was required to extract representative hospital samples effectively. Therefore, the data used in this study only included 160 hospitals (120 private and 40 public) extracted using propensity score matching-methods

Results

The data used in our study included 88,949 hospitalization cases. Readmission within 30 days after discharge was 1063 (1.2%) cases. Table 1 shows the univariate associations between readmission within 30 days and each independent variable including hospital volume and staffing. Readmission was more frequent in inpatients who were covered by Medical-aid than NHI beneficiaries (Medical-aid: 1.9%, NHI: 1.1%). It was also gradually increased by study periods. In the hospital-level variables, the

Discussion

The government of South Korea has tried effective management for increasing healthcare expenditures by increasing patients’ demand and chronic diseases. However, each hospital manager had no choice but to maintain hospital occupancy by growing competition of hospitals. There were many concerns about reducing quality of care [22]. The balance between quality and cost of health care can be explained as a part of the effectiveness of health care. In South Korea, total health expenditures accounted

Conclusions

Higher volume or staffing showed positive relation with improving efficiency and quality in care of inpatients due to LIDD. Therefore, health policy makers should consider providing incentives for hospitals with effective management for improving performance in patient care.

Authors’ contributions

K.T.H. and H.J.L. designed the study, researched data, performed statistical analyses and wrote the manuscript. S.I.J., E.C.P., and T.H.K. contributed to the discussion and reviewed and edited the manuscript. T.H.K. is the guarantor of this work and as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. W.K provided the scientific re-editing of this manuscript.

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