Fragmentation of health care and health care utilization
We investigate the effects of fragmentation in the health care sector on health care utilization and health outcomes. Over the last decades, healthcare has become more specialized. While specialization has enabled physicians to treat very complex diseases, it has reduced the coordination between different parts of the healthcare system. Related problems are likely to be more pronounced among vulnerable patient groups. We will embrace care fragmentation with regards to market structure, interactions between outpatient, inpatient and long-term care and the effectiveness of targeted policies in two health systems, Germany and Sweden. First, we will analyze the degree of fragmentation in outpatient care for individuals living with chronic disease and consequences from organizational change in market structure. For that purpose, we will investigate how the degree of care fragmentation is related to hospital admissions resulting from counter-indicated pharmaceutical treatment. Second, the project will address transitions from inpatient to outpatient care for patients suffering from mental health conditions. We will investigate the effect of fragmentation of outpatient treatment on several outcomes (sickness days, costs, re-admissions) for a cohort of patients who had a mental health-related inpatient stay in 2017. Third, we will examine the role of fragmentation at the intersection between curative and long-term care for older people to study the extent to which the rollout of a national initiative to improve co-ordination between providers had the intended effect to mitigate the effects of fragmentation. In all three projects, changes to the institutional setup within the healthcare system will be exploited to achieve identification of causal effects.