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- A spatial econometric analysis of the calls to the Portuguese National Health LinePublication . Simões, Paula; Carvalho, M. Lucília; Aleixo, Sandra; Gomes, Sérgio; Natário, IsabelThe Portuguese National Health Line, LS24, is an initiative of the Portuguese Health Ministry which seeks to improve accessibility to health care and to rationalize the use of existing resources by directing users to the most appropriate institutions of the national public health services. This study aims to describe and evaluate the use of LS24. Since for LS24 data, the location attribute is an important source of information to describe its use, this study analyses the number of calls received, at a municipal level, under two different spatial econometric approaches. This analysis is important for future development of decision support indicators in a hospital context, based on the economic impact of the use of this health line. Considering the discrete nature of data, the number of calls to LS24 in each municipality is better modelled by a Poisson model, with some possible covariates: demographic, socio-economic information, characteristics of the Portuguese health system and development indicators. In order to explain model spatial variability, the data autocorrelation can be explained in a Bayesian setting through different hierarchical log-Poisson regression models. A different approach uses an autoregressive methodology, also for count data. A log-Poisson model with a spatial lag autocorrelation component is further considered, better framed under a Bayesian paradigm. With this empirical study we find strong evidence for a spatial structure in the data and obtain similar conclusions with both perspectives of the analysis. This supports the view that the addition of a spatial structure to the model improves estimation, even in the case where some relevant covariates have been included.
- A spatio-temporal auto-regressive model for generating savings calls to a health linePublication . Paula Simões; M. Lucília Carvalho; Aleixo, Sandra; Gomes, Sérgio; Natário, IsabelUrgency admission is one of the most important factors regarding hospital costs, which can possibly be mitigated by the use of national health lines such as the Portuguese Saúde24 line (S24). Aiming future development of decision support indicators in a hospital savings context, based on the economic impact of the use of S24 rather than hospital urgency services, this study investigates spatio-temporal dependencies of the number of S24 calls generating savings in each Portuguese municipality, over the period 2010–2016, under an autoregressive approach. An econometric analysis of the savings obtained by the use of S24 is also carried out considering a savings index. Combining insights from classical spatial econometrics and from the analysis of spatio-temporal data, novel Bayesian Poisson spatio-temporal lag models are presented and applied in this paper. This extends to time the ideas of a Bayesian Poisson spatial lag model, considering both a parametric and a non-parametic structure for time and space-time effects. The results obtained for the savings index reveal that, over the last seven years, there has been a more comprehensive spatial effectiveness of the S24 line in solving the non-urgent emergency situations, that could be handled by primary health care services or in a self care basis.