The price of success: what is the impact of improving patients’ survival on utilisation of care?

Project: EU

Project Details


Unplanned emergency admissions absorb a large share of the resources allocated to the Health System and are growing at a fast rate in many European countries, for instance they absorb around 70% of all hospital bed days in England and have doubled in volume over the past 15 years. The drivers of this growth go beyond demographic factors and have not been properly investigated until recently due to the lack of rich longitudinal datasets following patients for many years and a gap in the transfer of knowledge between Economics and Public Health disciplines. I aim to fill this gap in the knowledge by applying state-of-the-art econometric models to a very rich longitudinal dataset on the population of Danish patients, thus offering a unique opportunity to inform new policies on the appropriate tools to manage the growing demand for emergency care.
The overarching hypothesis investigated by my research plan is that a severe health shock, such as a stroke, AMI, hip fracture, is likely to leave a permanent mark on the ability of the individual to take care of herself and overcome the next episode, including completely unrelated episodes and small episodes of illness that were previously resolved without the need of a hospital visit. The remarkable success in saving patients’ lives achieved in the past decades might have increased this population of high-risk users, who were unlikely to survive their first hospital admission in the past. My research will investigate the following questions:

1. What is the impact of improving patient survival on subsequent costs of care? I will model the impact of the survival effect on the costs of the health care resources accessed by the patient in the long run after their first acute admission. This will extend my previous studies that examined the survival effect on the number of subsequent emergency admissions only.

2. To what extent can primary care reduce the use and costs of secondary care? I will test for a substitution effect between primary care and hospital care in acute patients in the long run after their discharge from hospital. I will measure the extent to which primary care can reduce the impact of the survival effect identified under point 1.

3. To what extent can higher levels of integration of care reduce the use and costs of secondary care? I will test if increasing degrees of integration of care between acute and post-acute services, including social care services, can reduce the impact of the survival effect identified under point 1.

4. Is the impact of the survival effect different according to patient’s characteristics? I will decompose the heterogeneity in the survival effect by patient socioeconomic characteristics and identify the profiles of patients at high risk of using emergency care and with high costs. I will also examine patient heterogeneity under the primary care and integration of care analyses and identify socioeconomic characteristics that might affect patients’ response to these two factors.

Evidence from this research will inform policies aiming at reinforcing the financial sustainability of the Health System, and policies aiming at reducing hospital readmissions and improving the quality of care. The new evidence will also support health care managers in priority setting and planning of effective interventions targeting vulnerable patients who might be at higher risk of using health care resources after an acute event and who might be more likely to benefit from primary care support and integration of services.
Effective start/end date01/09/201931/08/2020


  • Health care costs
  • Quality of care
  • Demand for care
  • Hospitals
  • General Practices
  • Mortality rates
  • Readmission rates


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