The impact of pre-admission care on hospital mortality: results of an instrumental variable analysis from Italy

Background With healthcare spending projected to increase in the coming decades, the relationship between expenditure and health outcomes demands urgent attention. Objective This paper investigates the impact of health care spending on hospital mortality. We use data on 96,778 patients admitted for acute myocardial infarction (AMI) in the Lombardy region, Italy, in the years from 2007 to 2022 and combine them with information on expenditure on pharmaceuticals and outpatient visits made in the 12 months prior to hospital admission. Methods We adopt an instrumental variables approach to evaluate the causal impact of the total cost for pre-admission prescriptions and outpatient visits on hospital patient’s mortality. Results We find that pre-admission healthcare, particularly pharmaceutical spending, has a significant impact on reducing mortality rates within hospitals, with a 10% increase in pharmaceutical spending leading to a reduction in mortality by around 3.0 percentage points, although this result varies depending on the age group and the type of infarction. Conclusions The findings suggest that prioritizing pharmaceutical management can significantly reduce hospital mortality, highlighting a key area for healthcare optimization.