La integración vertical entre niveles asistenciales en el sistema sanitario español

Identifier:  TDX:2549

Handle: https://hdl.handle.net/20.500.11797/TDX2549

Authors:  López Panisello, María Belén

Abstract:
Aging, chronicity and dependency are increasing the need and the use of social health services in Spain (Sañudo and Garrote, 2005). The aging of the population and the prevalence of chronic diseases determine an important use of hospital resources (Dang et al., 2001), which have an impact on the country's health expenditure (Catlin et al., 2007). Under these circumstances, and in a context of economic crisis, the Spanish health system is characterized by the fragmentation between different levels of care. These aspects make difficult to provide adequate care to people with chronic health conditions. Acute hospitals must adapt to changes that occur in its environment in order to be competitive, provide greater continuity of care to patients and increase its efficiency (Vázquez et al., 2012). The reaction to these changes includes, as in other countries, such as the USA (Wang et al., 2001; Pomeranz and Ritchie, 2012; McHugh et al., 2014), the vertical integration of social health services by acute hospitals. In this context, hospitals need to know what internal and external factors are relevant to take vertical integration decisions, and also how they must be organized to successfully implement these decisions. In this research, a contingent model is proposed that considers the main relationships of formulation and implementation of vertical integration decisions and also the organizational adjustment. In order to test the hypotheses of the model, we have used the Partial Least Squares Structural Equation Modeling (PLS-SEM). The main conclusions suggest that the hospitals' decisions about the internal breadth and internal degree of vertical integration are based on their external context. As for the implementation of these decisions, the internal breadth has a positive direct effect on the efficiency and coordination of the care given to the patients. This effect improves when the model considers the mediation effect of coordination mechanisms or the organizational adjustment.