Bed Blocking and the City : An analysis of the factors explaining variation in the number of days associated with specific measures relevant to patient discharges one year after implementation of the coordination reform within the municipality of Oslo.

BACKGROUND: The policy implications of the “Coordination Reform,” introduced in 2009, became effective at the beginning of 2012. As a result, one of the major changes was a policy that shifted payment responsibility for patients ready for discharge to the municipalities beginning the same day a patient is deemed ready for discharge by the hospital. This policy is in an ongoing implementation phase and a variety of effects and changes has already been and will continue to be observed as a result of this measure. OBJECTIVE: To examine the effects, on both municipal and hospital behavior and decision making, one year after implementation within the municipality of Oslo. More specifically, to explain the variations in delayed discharge, for those somatic care patients who will require municipal services upon being discharged, by characteristics of the patients, the hospitals and the city districts. METHOD: Discharge data from before and after reform implementation was used to statistically test for significant differences between 2011 and 2012 in the periods of time related to delayed discharges. Probable explanations and predictions, for variations related to any significant differences, were then explained by multivariate linear regression using continuous time variables related to delayed discharge with independent demographic and geographic variables. Variables representing and explaining supply and demand of healthcare services within the city districts were then included. RESULTS: There was a statistically significant decrease in delayed discharges between 2011 and 2012. When looking at the individual city districts, this difference can be explained by a statistically significant positive effect of the proportion of inhabitants over the age of 80 and a significantly negative effect of per person spending on nursing care. The type of municipal service location to which patients were sent upon discharge also had a significant effect. The results indicate that districts with higher percentages of elderly inhabitants have greater delays in discharges, and districts with greater spending on nursing care have less discharge delays