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Abstract Background Although many countries have reformed public hospitals to reduce the imbalance of resources, there is limited information on the impact of hospital restructuring on communities and the regional healthcare system. The present study aimed to examine the effects of public hospital restructuring on the admission of elderly residents. Methods We analyzed a public hospital restructuring case in a secondary medical service area (SMSA) in Japan using administrative claims data. All consecutive patients aged 65 years or older who resided in the SMSA and were admitted to a hospital or visited a hospital between 36 months prior and 48 months after the restructuring were included. Effects of the restructuring on monthly admissions within the SMSA were evaluated using a segmented Poisson regression model and interrupted time-series analysis. Results A total of 58,929 admissions were analyzed. After the restructuring, admissions within the SMSA increased and reached the same level of admissions outside the SMSA. Interrupted time-series analyses revealed level (incidence rate ratio (IRR) 1.097, 95% confidence intervals (CI) 1.039–1.159, + 10.3% in two months) and slope (IRR 1.005, 95% CI 1.003–1.007, + 7 per month) changes in monthly admissions within the SMSA after the restructuring. Conclusions Monthly admissions of elderly residents within the SMSA increased after hospital restructuring, underscoring the importance of examining admissions within the neighborhood when assessing the impact of public hospital restructuring.
Kishimoto et al. (Thu,) studied this question.