Coordinating care across hospitals: how integration shapes patient mobility

Area of Science:

• Health services research
• Healthcare management
• Health economics

Background:

• France implemented territorial grouping for public hospitals in 2016 to enhance care coordination and efficiency.
• Policymakers aimed to improve integrated care, drawing on international models.
• The impact on care pathways and external referral relationships was uncertain.

Purpose of the Study:

• To evaluate the effect of territorial grouping on inter-facility patient transfers in France.
• To determine if administrative integration altered existing referral patterns or created new internal pathways.

Main Methods:

• Analysis of national hospital administrative data from 2013 to 2021.
• Utilized a synthetic difference-in-differences approach to estimate changes in transfer rates.
• Examined overall inter-facility transfers and transfers within the same territorial group.

Main Results:

• Small local hospitals saw a 1.25% increase in transfers to hospitals within their group post-formation.
• Transfers to hospitals outside the group remained stable, indicating minimal substitution.
• Findings suggest new coordination arrangements were added without disrupting existing external relationships.

Conclusions:

• Territorial grouping in France increased internal patient mobility, especially for local hospitals.
• External provider exchanges were not reduced, suggesting layered coordination.
• Administrative integration reshaped organizational behavior and patient flow within a regulated system.