Health Services and Outcomes Research Methodology

, Volume 9, Issue 3, pp 177–196 | Cite as

Exploring the small area variation and spatial patterns in outpatient treatments

  • Mickael Bech
  • Jørgen Lauridsen


The determinants for the number of outpatient hospital treatments across Danish municipalities are analysed using balanced panel data from the period 1998–2004. The determinants include socio-demographic variables, home help service, residential homes capacity, proxy variables for morbidity, utilisation of primary care services, accessibility of hospitals and a number of other factors. Panel effects in the form of intra-municipal correlation and heterogeneity across years are controlled for. Spatial spillover effects across municipalities will be investigated in order to disclose the spatial dynamics of outpatient treatments. The results reveal substantial heterogeneity and dependency across time, as well as presence of a significant spatial spillover effect. Reverse causalities among the number of hospital outpatient treatments and certain health systems characteristics are further controlled for. The results are shown to be highly sensitive to such adjustments, as the effects of determinants—including those over which the municipalities exert some control—are seriously overestimated if such features are ignored.


Small-area variation Spatial spillover Panel data Outpatient treatments Reverse causality 


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Institute of Public Health—Health EconomicsUniversity of Southern DenmarkOdense CDenmark
  2. 2.OUH—Odense University HospitalOdense CDenmark

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