Researchers: Erela Rotlevi ¹, Noa Dror Lavy ¹, Simon-Tuval Tzahit ², Royi Barnea ^3,4

Background: The opening of the Samson Assuta Ashdod University Hospital (henceforth: Assuta Ashdod) in 2017 provided a unique opportunity for a natural experiment to examine its influence on healthcare utilization (HCU).

Objectives: To examine the influence of this market entry on HCU.

Method: A retrospective study was conducted among Maccabi Health Services enrollees in the regions of Ashdod (n=94,575) and Netanya (control group, n=80,200) before and after this market entry. Based on difference-in-differences framework, we examined the change in HCU of Ashdod region’s enrollees compared to the control group and following the market entry using multivariable generalized estimating equations (GEE) models.

Findings: As hypothesized, after the market entry and compared to the control group, there was a 4% increase in specialists visits not requiring referral (RR=1.04, 95% CI: 1.03-1.06, p<0.001), a 4% increase in MRI and CT scans (RR=1.04, 95% CI: 1.01-1.08, p=0.022), and a 33% increase in emergency room visits (RR=1.33, 95% CI: 1.29-1.38, p<0.001). Unexpectedly, no changes were observed in the number of hospital admissions (RR=1.05, 95% CI: 0.97-1.14, p=0.250), and hospitalization days (RR=0.99, 95% CI: 0.94-1.04, p=0.668). Moreover, and unexpectedly, there was a 1% decrease in primary care physician visits (RR=0.99, 95% CI: 0.98-1.00, p=0.002), a 11% decrease in specialist's visits requiring a referral (RR=0.89, 95% CI: 0.86-0.91, p<0.001), and a 40% decrease in elective surgeries (RR=0.58, 95% CI: 0.55-0.60, p<0.001).

Conclusions: The establishment of Assuta Ashdod did not lead to increased utilization of all types of health services in the short term.

Recommendations: The unique model of maintaining the continuity of care that was adopted by the hospital and patients’ loyalty may led to the unique inter-relationship between the hospital and community care, and may be used as a model to allocate hospital and community care following a market entry of tertiary medical center.

Research end date: 01/2023