The costs of hospital at home: the case of the New Brunswick extra-mural hospital

Policy markers in number of countries have become concerned in recent years about steadily rising costs of hospital treatment. One approach which has been proposed involves moving some treatment out of traditional hospitals by making greater use of clinics and home care. The New Brunswick Extra Mural Hospital is a province-wide system designed to treat certain classes of patient at home rather than in hospitals. Its decentralized sturucture raises questions about coordination and control, and whether a single cost function can be said to exist for the whole system. This paper estimates a cost function for the Extra Mural Hospital and tests for structural differences across geographically separated delivery units. The results indicate that the system has been successful in maintaining a common cost sturcture, supporting the view that a decentralized hospital-at-home system can be run efficiently.