Consumption of expensive drugs: an indicator of determinants of hospitals’ attractiveness for patients?

Abstract

Hospitals’ attractiveness can impact the number of inpatients, and so health care expenditures. The objective is to identify parameters related to patients or drugs, which influence the proportion of inpatients not residing in the Paris area, and hospitalized in the Public Welfare Hospital of Paris (AP-HP). The analysis is limited to the use of the drugs that are listed on the French expensive drug formulary in 2012. A censored regression model, Tobit model, was developed in which the dependent variable is, for each drug, the ratio of the number of inpatients not residing in the Paris area, on the total number of inpatients receiving this drug. There are two kind of explanatory variables: those related to drugs and to patients. During 2012, 526091 doses – of the 113 drugs list – are administered to 30 499 inpatients. 13% of inpatients come from off the Paris area. According to the Tobit model, three variables have a positive impact on the ratio (innovative status, percentage of women and of Diagnosis Related Group coded as severe) and three a negative impact (orphan designation, percentage of elderly, biological origin). The therapeutic class and the Major Diagnostic Categories also have a significant impact depending on the statistical class. This study represents the first step of modelling the determinants of hospital’s attractiveness for patients, in order to better understand expensive drug expenditures.