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Rehabilitation Care Centres’ Performance: Ownership and patient’s social vulnerability

Abstract : Is there any difference in performance based on ownership of rehabilitation structures? In France, they can be private for-profit, non-profit or public. The type of ownership impacts the activity of the rehabilitation unit (as a public service mission), the management of healthcare institution staff and the institution healthcare’s organization. As a consequence, it may affect the performance. However, what do we mean by performance? This indicator is, in fact, multidimensional. In this paper, as performance indicators, I used improvement in dependence scores, in-death and discharge home. An administrative 2018-exhaustive rehabilitation stays is mobilized and four disorders are studied: stroke, chronic obstructive pulmonary disease (COPD), heart failure, and total hip replacement. For-profit rehabilitation unit outperform public sector hospitals. This result is obtained with a shorter daily patient care’s activity. I investigate mechanisms that cause differential benefits. Patient’s case-mix characteristics and hospital equipment as well as number of medical staff and non-medical staff, explain part of differences in performance based on ownership. Controlling for the social vulnerability (individual as well as French Ecological Deprivation Index) that impacts the profit of rehabilitation units, if less clearcut results are found, nevertheless I show for-profit rehabilitation unit outperform public sector hospitals. Using counterfactual, even if the simulations show that performance’s difference is explained by patient’s social vulnerability composition, a significant part remains unexplained. Living in richest areas implies higher impact in terms of ownership performance differences that shrink. Results demonstrate existing inequalities in health care access in spite of a nearly free of charge healthcare access.
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Preprints, Working Papers, ...
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Contributor : Caroline Bauer <>
Submitted on : Wednesday, June 2, 2021 - 9:44:44 AM
Last modification on : Friday, June 4, 2021 - 3:32:26 AM


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  • HAL Id : halshs-03010949, version 3



Carine Milcent. Rehabilitation Care Centres’ Performance: Ownership and patient’s social vulnerability. 2021. ⟨halshs-03010949v3⟩



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