EU funds as a catalyst of change for the Slovak healthcare system?
Published in Region 9(1), 2022
Co-authored with Jan Fidrmuc , Kristína Gardoňová, Lukáš Sekelský and Veronika Zlazcká.
Abstract
In the programming period 2007-2013, the European Structural and Investment Funds (ESIF) invested €237 million in Slovak hospitals. We investigate whether this injection of additional funds has improved the quality of healthcare in the targeted hospitals. As a measure of healthcare quality, we use the readmission rate (ratio of readmissions within 30 days over total hospitalizations) and the mortality rate. Our results show a statistically significant but small effect of ESIF on the readmission rate but not on the mortality rate. We argue that these results suggest that the main problem in Slovak healthcare is low productivity rather than a lack of funding.
Motivation
- The EU invested in the 2007-2013 237 million Euros in Slovak hospitals, in a country that lags behind other EU countries in preventive healthcare and quality of primary healthcare provision.
- Lack of empirical evidence on the effect of EU Funds on healthcare quality in the EU.
Research question
- Do the EU Funds increase the quality of healthcare in Slovakia?
- What is the impact of subcategories of EU Funds (infrastructure, equipment, and personnel and other expenses)?
Contribution
- Empirical analysis of the impact of EU Funds on quality of healthcare.
Empirical strategy
- Estimating the impact of EU Funds on healthcare quality outcomes of Slovak hospitals (67 hospitals, of which 30 received EU Funds at some point) in 2010-2017.
- Dependent variables: readmission and mortality rates.
- Variable of interest: EU Funds in Euros (overall, infrastructure, equipment, and personnel and other expenses).
- Control variables: hospital level (capacity, occupancy, perinatal mortality, having intensive care or oncology.sections, number of CT and MR machines, stae or private hospital or regional hospital) and regional level controls (average wage, old age dependency ratio, Roma share).
- Method: OLS.
Results
- Negative impact of lagged EU funds on readmission rate in hospitals, although econominically insignificant.
- This effect is mainly driven by construction and reconstruction of hospitals.
- Investment into equipment results in higher readmission rate (could be the case of hospitals becoming more important and receiving more acute patients).
- No effect of EU Funds on mortality rates.