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Place or patient as the driver of regional variation in healthcare spending - Discrepancies by category of care
Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.ORCID iD: 0000-0003-2325-5375
Karlstad Business School, Karlstad University, Sweden.
School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, USA.
2024 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 342, article id 116571Article in journal (Refereed) Published
Abstract [en]

We study how much regional variation in healthcare spending is driven by place- and patient-specific factors using a random sample of 53,620 regional migrants in Sweden. We find notable differences depending on the category of care, with place-specific factors having a significantly larger impact on specialized outpatient care compared to inpatient and pharmaceutical care. The place effect is estimated to 75% of variation in specialized outpatient care, but 26% or less in variations in inpatient care, and 5% in prescription drug spending. We also find that the empirical estimator has a substantial impact on the estimates of the place-specific effect. The results based on the traditional approach in the literature with two-way fixed effects and event-study models produce much larger estimates of the place-specific effect compared to results based on recently developed heterogeneity-robust models. For total healthcare spending, the traditional two-way fixed effects model estimates a place effect of 78%, while the heterogeneity-robust estimator finds a place effect around 10%. This finding indicates that previous results in this literature, all based on traditional two-way fixed-effects regressions, should be interpreted with care.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 342, article id 116571
Keywords [en]
Event study, Healthcare spending, Movers, Regional variation, Two-way fixed effects
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:oru:diva-110708DOI: 10.1016/j.socscimed.2024.116571ISI: 001161924700001PubMedID: 38215643Scopus ID: 2-s2.0-85182385969OAI: oai:DiVA.org:oru-110708DiVA, id: diva2:1827620
Funder
Swedish Research Council, 2018–02708Available from: 2024-01-15 Created: 2024-01-15 Last updated: 2024-03-04Bibliographically approved

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