Efficiency and optimal size of hospitals: Results of a systematic search

Abstract

BackgroundNational Health Systems managers have been subject in recent years to considerable pressure to increase concentration and allow mergers. This pressure has been justified by a belief that larger hospitals lead to lower average costs and better clinical outcomes through the exploitation of economies of scale. In this context, the opportunity to measure scale efficiency is crucial to address the question of optimal productive size and to manage a fair allocation of resources.Methods and findingsThis paper analyses the stance of existing research on scale efficiency and optimal size of the hospital sector. We performed a systematic search of 45 past years (1969–2014) of research published in peer-reviewed scientific journals recorded by the Social Sciences Citation Index concerning this topic. We classified articles by the journal’s category, research topic, hospital setting, method and primary data analysis technique. Results showed that most of the studies were focussed on the analysis of technical and scale efficiency or on input / output ratio using Data Envelopment Analysis. We also find increasing interest concerning the effect of possible changes in hospital size on quality of care.ConclusionsStudies analysed in this review showed that economies of scale are present for merging hospitals. Results supported the current policy of expanding larger hospitals and restructuring/closing smaller hospitals. In terms of beds, studies reported consistent evidence of economies of scale for hospitals with 200–300 beds. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds.

The efficiency in the ordinary hospital bed management in Italy: an in-depth analysis of intensive care unit in the areas affected by COVID-19 before the outbreak

“…CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) decade that led the regional health services to close a significant number of local small dimension hospitals that generally have higher costs [5]. This lack of beds is confirmed by a recent study of the OECD that reported that our country counts 2.6 hospital beds per 1000 inhabitants [6], ranking Italy at the 19 th place over 23 countries with Germany having more than 6 beds per 1000 inhabitants.…”

Exploring the Spatial Interdependence in Efficiency of Private Hospitals in Pakistan

“…They have a small number of beds for admitted patients. The size of the hospitals has real impacts on the health outcomes according to the recent literature (Giancotti, Guglielmo, & Mauro, 2017;Kristensen, Olsen, Kilsmark, & Pedersen, 2008). Whether the profit-seeking behavior of small private hospitals also exists for inpatient care is the next logical question.…”

“…Therefore, hospitals cannot increase the number of admitted patients beyond their capacity. According to the empirical literature, the size of the hospital has a real impact on the final health outcome (Giancotti et al, 2017). As the small hospitals specialized in ambulatory care, therefore hospitals compete with hospitals in their neighborhood to attract more patients to increase their profit levels.…”

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