Efficiency in the hospital sector A study of elective surgery in Spain.

This thesis provides a comprehensive assessment of the reasons for the differences in hospital utilisation. The research starts with a quantitative analysis of the reasons for the differences in the length of stay and inpatient costs for elective surgery. Both these topics are central to efficiency and value for money in the hospital sector. Subsequently, a qualitative component is introduced involving a questionnaire answered by surgeons. A comprehensive statistical model is developed by using 1991 data from a number of hospitals in Spain. The model includes a large set of control variables: health status indicators, hospitalization-related variables, hospital and doctors characteristics and regional supply. Using a large data set, the analysis confirms many hypotheses concerning the reasons for the variations in the length of stay and inpatient costs. Longer stays were estimated for a) patients with more severe Diagnoses Related Groups; b) comorbidity or multiple diagnoses; c) complications after the operation; d) patients over 65 year old; e) admitted through the emergency room or referred by the Internal Medicine Department; f) admitted to hospital on a Friday or a Saturday and discharged on a Monday; g) living in an area with a relative large supply of surgeons, beds per specialty and resident surgeons. In contrast, patients who were admitted to a hospital with a high turnover rate, a high percentage of operations and a high number of total hospital beds experience shorter lengths of stay. Higher costs were estimated for patients with a) longer lengths of stay; b) longer operating theatre minutes; c) admitted through the emergency room; d) and in areas with a high number of surgeons. In contrast, hospitals with a high number of beds per specialty and a high number of total hospital beds experience lower hospital costs.