In a comprehensive analysis, a research team from MedUni Vienna in collaboration with Gesundheit Österreich GmbH has shown that the number of hospital admissions for depression in Austria exhibits significant regional differences and an urban-rural divide. The researchers analysed the hospital admission rates per 1,000 inhabitants of all’Austrian municipalities over five years. As the study shows, admission rates depend significantly on two factors: proximity to hospitals and the availability of psychiatric care in private practice. This means that residents of municipalities with hospitals or with hospitals in neighbouring municipalities are statistically more likely to receive inpatient treatment for depression. The results point to possible discrepancies between patients’ needs and the medical care structure and were recently published in the specialist journal "Health Policy".
In the study, Michael Berger and Judit Simon from the Department of Health Economics at MedUni Vienna’s Center for Public Health examined data from 93,302 hospital episodes between 2009 and 2014 from 2114 municipalities. The results show that hospitalisation rates due to depression are significantly higher in communities with hospitals than in communities without. The differences between urban, suburban and rural areas are particularly striking. In suburban communities, admission rates for depression are up to 13 per cent higher than in rural communities, indicating a possible influence of hospital supply on the demand for inpatient treatment. In communities with hospitals, the rate of depression admissions is up to 12 per cent higher than in those without.
The analysis also shows a spatial "spillover" effect: if a hospital is located in a municipality, it not only affects hospital admission rates in the local population but also in neighboring municipalities. This effect can be observed even for general hospitals without dedicated psychiatric wards, suggesting that the availability of hospital resources in general influences patient flows across municipal boundaries. "These geographic patterns of admission rates show that the mere presence of hospitals plays a strong role in determining whether patients with depression are hospitalised, even if no specific psychiatric beds are available," clarifies study author Michael Berger.
The results also suggest that the high number of hospital admissions due to depression in certain regions cannot be explained solely by the actual need for inpatient care, but also by the structure of healthcare provision. A lack of outpatient care and the geographical concentration of hospitals in urban and suburban areas may lead to an inefficient distribution of healthcare resources. The authors conclude from the results that a better link between inpatient and outpatient healthcare facilities and targeted promotion of psychiatric care could help to reduce the number of avoidable hospital admissions. "Improving timely access to outpatient care and early-stage treatment can reduce the burden of avoidable hospitalisations on patients and public budgets and close a gap in unmet need for care for vulnerable populations," emphasises study author Judith Simon.
Publication: Health Policy
Urban-rural disparities in hospital admissions for depression in Austria: A spatial panel data analysis.
Michael Berger, Martin Zuba, Judit Simon
https://doi.org/10.1016/j.healthpol.2024.105209
