Jul 9, 2013

Decentralization and centralization of healthcare resources: investigating the associations of hospital competition and number of cardiologists per hospital with mortality and resource utilization in Japan

Health Policy
Sungchul ParkY Imanaka


To investigate the associations of hospital competition and number of cardiologists per hospital (indicating the decentralization and centralization of healthcare resources, respectively) with 30-day in-hospital mortality, healthcare spending, and length of stay (LOS) among patients with acute myocardial infarction (AMI) in Japan. We collected data from 23,197 AMI patients admitted to 172 hospitals between 2008 and 2011. Hospital competition and number of cardiologists per hospital were analyzed as exposure variables in multilevel regression models for in-hospital mortality, healthcare spending, and LOS. Other covariates included patient, hospital, and regional variables; as well as the use of percutaneous coronary intervention (PCI). Hospitals in competitive regions and hospitals with a higher number of cardiologists were both associated lower in-hospital mortality. Additionally, hospitals in competition regions were also associated with longer LOS durations, whereas hospitals with more cardiologists had higher spending. The use of PCI was also associated with reduced mortality, increased spending and increased LOS. Centralization of cardiologists at the hospital level and decentralization of acute hospitals at the regional le...Continue Reading

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Mentioned in this Paper

Myocardial Infarction
Hospital Mortality
Expenditures, Indirect
Logistic Models
Vascular Medicine
Metaplastic Cell Transformation
Regression Analysis
Cross Infection
Hospital Stay

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