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Licensed Unlicensed Requires Authentication Published by De Gruyter June 13, 2019

Health Care Home: Early Evidence from Linked Administrative Data in New Zealand

Kabir Dasgupta EMAIL logo and Gail Pacheco
From the journal The B.E. Journal of Economic Analysis & Policy
https://doi.org/10.1515/bejeap-2019-0054

Abstract

Our analysis presents a case study on the impacts of Health Care Home (HCH) – a large-scale technology-based healthcare innovation in New Zealand’s primary healthcare system. For our analysis, we link the registered population of health practices within the Wellington region to administrative hospital admission data for quarterly periods between 2014 and 2017. By employing variation in the timing of HCH implementation across practices (selected via propensity score matching), we estimate differences-in-differences models to investigate the effects of the intervention on multiple patient outcomes. Additionally, we incorporate a number of empirical specifications to test the robustness of estimates. HCH results in a statistically significant reduction in the likelihood of emergency department (ED) presentations by 6–8 %, with no significant impacts on other health outcomes. The impact on ED presentations aligns with the expectation that the HCH intervention would produce downstream effects of a reduced economic burden on public hospital services.

Keywords: Health Care Home; administrative data; primary care; emergency department presentation; difference-in-differences
JEL Classification: I11; I18; C12

Appendix

A
Table 6:

Number of registered individuals per practice-quarter.

2014 Quarters2015 Quarters2016 Quarters2017 Quarters
HCH implementation quarterPractice1st2nd3rd4th1st2nd3rd4th1st2nd3rd4th1st2nd3rd4th
11,7731,7811,8031,8221,8291,8351,8641,8741,8881,8931,9241,9471,9681,9952,0402,079
2016q328,3028,4888,6418,8419,0059,1839,3609,6099,8059,97510,24410,47110,74210,98711,25711,645
31,4031,4281,4721,5071,5371,5571,5941,6221,6961,6831,7501,7921,8641,9252,0042,104
4373387395412420429442457462471476490514531549587
52,5672,6072,6462,7002,7322,7692,8332,8472,9012,9463,0013,0773,1593,2403,3163,414
2017q463,2013,2463,3053,3703,4423,5413,6503,7273,8633,9474,0734,2124,3554,5034,6594,850
2016q471,7591,8081,8261,8431,8671,9111,9521,9852,0232,0442,1082,1362,2052,2572,2872,357
86,5846,7266,8727,0667,2877,4367,6327,7977,9768,1368,4308,6388,8609,0909,3339,683
9693713724732757767784799811830849860877901923954
2017q3105,7375,8445,9746,1216,2376,3906,5536,7036,9537,1537,4067,6337,8158,1128,3508,673
118558808929219529721,0011,0431,0701,1151,1521,1771,2181,2791,3531,421
126416516656817257567998298478819109399719961,0251,056
2018q2131,8921,9221,9752,0322,1052,1792,2962,4082,5562,6612,8472,9773,1543,3223,4853,666
142,0562,0862,1162,1452,1612,1902,2372,2812,3082,3302,3862,4112,4402,4852,5352,609
153,7963,8223,8873,9814,0734,1384,1914,2114,2734,3404,3674,3844,4414,5224,5614,656
162,4892,5322,5582,6232,6542,6792,7232,7542,7892,8312,8572,9132,9623,0203,1073,185
2017q4177,0057,1147,2367,3557,4817,5997,7058,0688,1968,3388,4868,6128,7799,0099,1989,344
2018q1186,3266,3816,4476,5686,6446,7146,8076,8796,9767,0867,1887,2607,3477,4587,5907,720
2017q4195,3605,509
20373381382387401410418433437438441453468485497501
212,6032,6542,6992,7492,7812,8622,9102,9613,0383,1243,2023,2993,3983,4863,5823,712
221,8501,8831,8861,9071,9191,9561,9721,9952,0152,0282,0602,0792,0932,1112,1442,180
234,6834,7294,8014,8915,0045,1485,2705,4275,5895,6915,9406,1196,3796,6286,8147,056
243,5223,5693,6363,6913,7233,7673,8133,8903,9293,9773,9934,0874,1644,2854,3484,429
255,0315,1165,1905,2835,3785,4685,5675,6625,7505,8496,0056,1166,2306,3986,5316,698
263,5393,6003,6313,6573,6883,7443,8133,8624,0064,0934,2114,3234,4214,6084,7234,902
2017q3278,1468,2488,3538,4638,6398,7568,8718,9389,0489,1679,3369,4549,5969,81310,00210,207
2018q1281,5981,6161,6341,6491,6661,6841,7011,7121,7331,7561,7821,8171,8601,9031,9321,991
291,2481,2611,2811,2981,3051,3481,3861,4201,4421,4661,4901,5031,5131,5441,5821,607
2018q3304,6004,6554,7244,7984,8634,9245,0935,1575,2205,3105,4045,5075,6155,7345,8505,988
311,6091,6311,6721,7041,7211,7411,7631,7701,7741,7801,8071,8301,8551,8641,8861,913
326,6266,7316,8176,9037,0117,0987,1707,2577,3327,4637,5857,6997,8287,9698,1228,293
334,2324,3664,4094,4904,5524,6224,7124,7764,8694,9625,0435,1035,2035,3215,4625,586
341,8741,8831,9191,9651,9912,0362,1402,1722,2392,2452,3072,3542,3942,4682,5062,574
2016q3352,1982,2402,3012,3272,3622,3722,4012,4262,4742,5082,5482,5972,6312,6802,7452,822
362,2512,2762,2982,3222,3642,4132,4812,5422,5922,6412,7032,7502,8162,8682,9333,012
373,0743,1133,1353,1693,1993,2293,2533,2733,3193,3453,4183,4913,5433,6003,6503,731
385,5845,6415,7345,8535,9486,0606,1476,2596,3736,4816,6416,7516,8737,0527,2317,440
394,4174,4514,5174,5984,7184,7704,8664,9855,0725,1805,3055,4215,5225,6535,8115,943
2017q4403,1373,2043,2523,3363,4173,4753,5133,5423,5983,6343,7683,8263,8903,9504,0284,148
41269278276286283295313331344351360373387411431452
421,5761,6231,6681,7281,7501,7741,8161,8511,8761,9121,9581,9922,0322,0902,1522,289
2018q1434,1434,2014,2584,2924,3284,3714,4434,4694,5494,6234,7124,7714,8724,9655,0545,173
2018q2443,8593,9674,0554,1314,1724,2554,3634,4354,5084,5964,6594,7344,8424,9555,0665,231
2016q3456,6766,7516,8056,8606,9397,0637,1767,2817,4137,5017,6187,7207,8708,0638,2578,452

  1. Notes: The practice identifiers marked in bold implemented the health care homes model.

Table 7:

Difference-in-differences model with binary health events using all practices.

Dependent variables (binary indicator of health events)
Excess stayAcute admissionED admissionASH eventReadmission
Sample mean0.0110.0170.0150.0060.002
Model 1: Time and practice-specific fixed effects
HCH implementation−0.00035−0.00013−0.00120**−0.00024−0.00010
(0.00022)(0.00032)(0.00048)(0.00028)(0.00020)
Model 2: Model 1 + demographic controls (age, sex, ethnicity, quintile)
HCH implementation−0.00033−0.00010−0.00118**−0.00023−0.00009
(0.00023)(0.00032)(0.00050)(0.00029)(0.00016)
Model 3: Model 2 + practice-specific linear time trends
HCH implementation−0.000180.00011−0.00111***−0.000020.00011
(0.00030)(0.00034)(0.00033)(0.00018)(0.00027)
Model 4: Model 2 + event study
HCH implementation−0.000280.00002−0.00135***−0.00011−0.00003
(0.00029)(0.00031)(0.00038)(0.00023)(0.00022)
Pre-treatment (δpt)0.000000.000060.000030.000040.00001
(0.00004)(0.00005)(0.00005)(0.00003)(0.00002)
δptX HCH implementation−0.00004−0.00027*0.00001−0.00021**−0.00008
(0.00014)(0.00016)(0.00017)(0.00010)(0.00006)
Observations2,819,7512,819,7512,659,2602,819,7512,819,751
Individuals235,457

  1. Notes: The marginal effects from probit regressions using all the matched practices along with the respective standard errors (in parentheses) are reported in the above table. The standard errors are corrected for clustering at the practice-level. ***, **, * denote statistical significance at the 1 %, 5 %, and 10 % levels, respectively. We estimate probit regressions for Models 1–4.

  1. Conflict of Interest: The authors hereby acknowledge that the analysis does not involve any conflict of interest, as per the journal requirements.

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Published Online: 2019-06-13

© 2019 Walter de Gruyter GmbH, Berlin/Boston

From the journal
The B.E. Journal of Economic Analysis & Policy
The B.E. Journal of Economic Analysis & Policy
Volume 19 Issue 3

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