The purpose of this paper is to shed light on the ongoing Dutch health system reforms and identify whether hospital costs and hospital outcomes have changed over time. We present an empirical analysis that is based on granular micro-costing data and focuses on conditions for which mortality is indicative of outcome quality, that is, acute myocardial infarction (AMI), chronic heart failure (CHF), and pneumonia (PNE). We deploy a dataset of more than 80,000 inpatient episodes over 5 years (2013–2017) to estimate regression models that control for variation between patients and hospitals. We have three main findings. First, our results do not indicate significant outcome improvements over the years; that is, there is no time trend for mortality. Second, there is heterogeneity in cost developments: for patients who survive their inpatient stay, our data indicate that costs increase significantly by 0.9% per year for AMI patients, while costs decrease significantly by 1.7% per year for CHF patients and by 1.9% per year for PNE patients. For patients who pass away during their inpatient stay, our data do not indicate significant time trends. Third and finally, our results suggest the existence of substantial cost variation between hospitals.

中文翻译：

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荷兰医院是否挽救了生命并降低了成本？2013-2017 年的纵向患者水平分析

本文的目的是阐明荷兰正在进行的卫生系统改革，并确定医院成本和医院结果是否随时间发生了变化。我们提出了一项基于精细微观成本数据的实证分析，重点关注死亡率指示结果质量的情况，即急性心肌梗死 (AMI)、慢性心力衰竭 (CHF) 和肺炎 (PNE)。我们部署了超过 5 年（2013-2017 年）超过 80,000 次住院事件的数据集，以估计控制患者和医院之间差异的回归模型。我们有三个主要发现。首先，我们的结果并未表明多年来的显着改善；也就是说，死亡率没有时间趋势。其次，成本发展存在异质性：对于在住院期间幸存下来的患者，AMI 患者每年显着增加0.9%，而CHF 患者每年显着减少 1.7%，PNE 患者每年显着减少1.9%。对于在住院期间去世的患者，我们的数据并未显示显着的时间趋势。第三，也是最后，我们的结果表明医院之间存在巨大的成本差异。