Unique patterns of healthcare utilization following the opening of the Samson Assuta Ashdod University Hospital

Our aim was to examine the influence of the market entry of Samson Assuta Ashdod University Hospital on community and hospital-based healthcare utilization (HCU). A retrospective study was conducted among Maccabi Health Services enrollees in the regions of Ashdod (n = 94,575) and Netanya (control group, n = 80,200) before and after this market entry. Based on difference-in-differences framework, we examined the change in HCU of Ashdod region's enrollees compared to the control group and following the market entry using multivariable generalized estimating equations models. Our results revealed that, as hypothesized, after the market entry and compared to the control group, there was a 4% increase in specialists visits not requiring referral (RR = 1.04, 95% CI 1.03-1.06, p < 0.001), a 4% increase in MRI and CT scans (RR = 1.04, 95% CI 1.01-1.08, p = 0.022), and a 33% increase in emergency room visits (RR = 1.33, 95% CI 1.29-1.38, p < 0.001). Unexpectedly, no changes were observed in the number of hospital admissions (RR = 1.05, 95% CI 0.97-1.14, p = 0.250), and hospitalization days (RR = 0.99, 95% CI 0.94-1.04, p = 0.668). Moreover, and unexpectedly, there was a 1% decrease in primary care physician visits (RR = 0.99, 95% CI 0.98-1.00, p = 0.002), a 11% decrease in specialists visits requiring a referral (RR = 0.89, 95% CI 0.86-0.91, p < 0.001), and a 42% decrease in elective surgeries (RR = 0.58, 95% CI 0.55-0.60, p < 0.001). We conclude that this market entry was not translated to an increase in utilization of all services. The unique model of maintaining the continuity of care that was adopted by the hospital and patients' loyalty may led to the unique inter-relationship between the hospital and community care.