Journal article

Complements or substitutes? Associations between volumes of care provided in the community and hospitals

Yiu-Shing Lau, Gintare Malisauskaite, Nadia Brookes, Shereen Hussein, Matt Sutton



Policymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between Novemb..

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Awarded by National Institute for Health Research (NIHR) Policy Research Programme

Funding Acknowledgements

We are grateful to participants in the UK Health Economists' Study Group meeting in January 2020 and the 3rd National Primary Care Dataset Workshop February 2020 for comments on earlier versions. This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Health and Social Care Systems and Commissioning, [PR-PRU-1217-20801]. The views expressed are those of the authors and not necessarily of the NIHR or the Department of Health and Social Care.