Coordinating care across hospitals: how integration shapes patient mobility

Loïc Guérin and Nicolas Sirven ()
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Loïc Guérin: UR - Université de Rennes, EHESP - École des Hautes Études en Santé Publique, ARENES - Arènes: politique, santé publique, environnement, médias - UR - Université de Rennes - Institut d'Études Politiques [IEP] - Rennes - EHESP - École des Hautes Études en Santé Publique - UR2 - Université de Rennes 2 - CNRS - Centre National de la Recherche Scientifique, METIS - Département Méthodes quantitatives en santé publique - EHESP - École des Hautes Études en Santé Publique
Nicolas Sirven: EHESP - École des Hautes Études en Santé Publique, ARENES - Arènes: politique, santé publique, environnement, médias - UR - Université de Rennes - Institut d'Études Politiques [IEP] - Rennes - EHESP - École des Hautes Études en Santé Publique - UR2 - Université de Rennes 2 - CNRS - Centre National de la Recherche Scientifique, RSMS - Recherche sur les services et le management en santé - UR - Université de Rennes - EHESP - École des Hautes Études en Santé Publique - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique, IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, UR - Université de Rennes

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Abstract: Background: In 2016, France reformed its health system by requiring public hospitals to form territorial groups. Policymakers, following experiences with integrated care provision in the United States and NHS-type networks in Italy and England, expected these groups to improve coordination and system efficiency. However, it remains unclear whether such administrative integration creates new care pathways within groups or substitutes for existing referral relationships with external providers. Methods: We analyzed national hospital administrative data from 2013 to 2021. Changes in inter-facility transfer rates were estimated using a synthetic difference-in-differences approach. The main outcome was the annual percentage of patients transferred to another hospital, overall and within the same group. Results: Following group formation, smaller local hospitals experienced an average increase of 1.25 percentage points in transfers to hospitals within their group. Transfers to hospitals outside the group remained broadly stable, suggesting limited substitution away from pre-existing referral channels. Conclusions: Territorial grouping are associated with an increase in internal patient mobility, particularly among local hospitals, without reducing exchanges with external providers. These findings suggest that administrative integration may have layered new coordination arrangements onto existing care pathways and reinforced patterns of functional specialization. The results contribute to understanding how network-based integration reshapes organizational behaviour and patient mobility in regulated health systems.

Keywords: Agency theory; Mixed markets; Executive behavior; Patients transfer; Healthcare integration (search for similar items in EconPapers)
Date: 2026-06-30
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Published in European Journal of Health Economics, inPress, ⟨10.1007/s10198-026-01939-y⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05677873

DOI: 10.1007/s10198-026-01939-y

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