Urban–rural disparities in hospital admissions for depression in Austria

Medical practice variation in mental healthcare is a useful indicator for policymakers aiming to improve the efficiency of healthcare delivery. Previous studies have shown strong regional variation in healthcare utilisation in Austria, which seems to be a by-product of regionalised institutional rules and healthcare service mix rather than epidemiology. We use a set of routine municipality-level healthcare data on hospital admissions for depressive episodes of adult Austrian patients from 2009 to 2014 to examine spatial patterns in healthcare utilisation in mental health. Our data contains 93,302 hospital episodes by 65,908 adult patients across 2114 municipalities. We estimate a random-effects spatial autoregressive combined model to regress log hospital admission rates on hospital supply and urbanicity as proxies for municipality healthcare service mix alongside demographic and socioeconomic controls. We find that admissions for depression are substantially higher in suburban municipalities compared to rural areas and in municipalities with hospitals compared to those without. The spatial structure suggests positive spatial spillovers between neighbouring municipalities. Our main results are stable across virtually all model specifications used for robustness and show that healthcare service mix and supply of hospital services strongly correlate with spatial patterns of hospital admission rates in the population. Promoting timely access to high-quality primary care and early-stage treatments may reduce the burden of avoidable depression-related hospitalisations for patients and public budgets, and close a gap of unmet need for care of vulnerable populations.