Snail and Robinson [81] presented a review and assessed the state of empirical research on hospital organizational change. Two articles conducted analyses within a sample composed of district, regional, psychiatric and specialized hospitals [63], and by central, district and level 1 hospitals (level 1 hospitals provide a limited range of specialties and refer patients to other types of hospitals) [71]. https://doi.org/10.1371/journal.pone.0174533.t007. ��xڍ�WҚA�`�w��,#��}���9(�R+�>�>��i���%&4�4�zP�q� �����xBE[�b5$c��K�xܿ�D���� ��"��`�A3� @�8��'��>�x��Tʵ쀻L�. Additionally, significant economies of scale were found in emergency department care [93], supporting a possible expansion of emergency department size policy to improve the cost efficiency of these services. The average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. Occupancy rate is calculated as the average daily census (from the American Hospital Association) divided by the number of hospital beds. The total of initial records was 2.093.342 papers. It is measured in number of beds per 1 000 inhabitants. https://doi.org/10.1371/journal.pone.0174533.t011. In contrast, 4 studies included rural and urban hospitals (33%). Specifically, mergers occurring later in the study period and mergers between similarly sized hospitals displayed greater change in operating characteristics than did mergers occurring earlier in the study period and mergers between hospitals of dissimilar size. Estimating Size Here are a few general rules-of-thumb that can help determine the size of your hospital. An important contribution concerning hospital size was made by Tsai and Jha [85]. h��Y�n۸~���~vQt��H�ri�t�4���6 Geographical disparities in health resource allocation and county hospital productivity were noted. [2] assessed technical and scale efficiency and productivity changes of public municipal hospitals in Angola. Four articles were found under the topic Hospital cost efficiency. All topics investigated are explained in Table 8. Label. Hospitals’ inefficiency reflected the revenue-based behaviour of hospitals in which unnecessary care, over-prescription of drugs, and the adoption of high-tech treatments were commonly found. The American Hospital Association conducts an annual survey of hospitals in the United States. Cross‐sectional. Hospital A Diagnostic and Treatment Services EMERGENCY DEPARTMENT (68 Patient Stations) Unit Room or Space Qty. Hospital revenue trends are influenced in large part by hospital size or, more specifically, by hospital bed count. Generally, Business and Economic journals welcome articles in all areas of business and economics research. Eight studies employed mixed methods (35%). The increase in the number of patients with very short lengths of stay, particularly those admitted as emergencies, has contributed to this reduction ( … The author demonstrated that, in some cases, pure technical inefficiency was the driving force for pulling down the overall efficiency of these hospitals [35]. Two articles were collocated under the topic Effect of market and organizational structure on hospital efficiency. Most of these articles were published in the period 2001–2014. In contrast, some authors observed that as one hospital's unit increases in size, the cost per patient per day falls [83], concluding that economies of scale and scope depend upon the category of the hospital in addition to the number of beds and volume of output [84]. The Ministry of Health publishes hospital bill sizes, operation fees, and dental fees to encourage providers to charge more competitively and also enable patients and caregivers to make more informed choices about their providers. Analysing hospitals’ costs in relation to size [47, 48], some of articles found that economies of scale were present with an optimum hospital size of approximately 230 beds [4]. In contrast, Kristensen et al. Bed size 200 to 299: 1,112 69. No, Is the Subject Area "Quality of care" applicable to this article? doi:10.1371/journal.pmed1000097. In the first decade of the study, authors concentrated on the shape of the hospital industry's cost function and on the importance of the relationship between hospital costs and the scale of output, called "returns to scale" or "economies of scale”. Authors calculated the technical and scale efficiencies of sample hospitals and provided several contributions for research and practice to understand factors affecting hospitals’ efficiency. The techniques used are primarily based on non-parametric DEA, but there is an increasing use of parametric techniques such as SFA, as reported in. I grew up and went through school (in a medium-sized Southern city) thinking that a "small" hospital was 1000 bed was a "large" hospital. Studies published in Health Care Science and Services journals highlighted that the effects and the benefits of the mergers depend on the type of the organizations involved; in particular the aggregations among similar organizations appears to be very effective. Yes We found many articles that argue about the implications of mergers and of health reform on hospitals’ efficiency and on quality of care. The number and wide range of publications justifies a review that allows, on the one hand, systematization of the literature and, on the other hand, identification of areas not treated, whose study will contribute to the evolution of science in terms that relate not only to knowledge but also to proactivity. No, Is the Subject Area "Research and analysis methods" applicable to this article? The global hospital gowns market size was valued at USD 2.7 billion in 2019 and is expected to grow at a compound annual growth rate (CAGR) of 13.0% from 2020 to 2027. Weaver and Deolalikar [84] analysed economies of scale using a sample of 654 public Vietnamese hospitals. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds. Concerning quantitative methods, DEA analysis was preferred (61%). The authors showed that different hospitals might have different optimal sizes or different efficient modes of operation, depending upon location, the population they serve, and the policies their respective provincial governments wished to implement. Concerning hospital location, most of the articles did not specify this aspect (67%). Only one study was a descriptive study (4%) [103]. Our objectives were to analyse most topics investigated, the authors’ conclusions in this field and the methods used for the analysis and measurement of efficiency in the hospital sector. The overall efficiency at the national level decreased slightly. County hospitals in the eastern region tended to have better overall scale and technical efficiency in comparison to the middle and the western regions. For more information about PLOS Subject Areas, click https://doi.org/10.1371/journal.pone.0174533.t012. This section provides details on the size of medical bills according to medical conditions and procedures and answers general questions on the range of fees to expect. Whilst this systematic search aimed to be rigorous, there are a few limitations. The indicator is presented as a total and for curative care and psychiatric care. Finally, Peyrache [107] employed DEA analysis and the directional distance function to investigate hospital mergers and potential gains. In the second phase, of the 131 articles, we included only those journals with the Thomson Reuters Impact Factor published in 2013, as a proxy for the influence of publications. According to the illustration of economies of scale, increasing the size of a hospital unit can result in product increases of more than double or more than triple; therefore, unit production costs decrease. Which factors influenced the hospitals scale efficiency? Table 21 shows the frequency distribution of articles published in Operations research & Management journals by primary data analysis technique. Eleven studies used a Cost function model to estimate hospital productivity (25%). Seven studies performed analysis including only general/acute-care hospitals (30%). 3. Three articles discussed the optimal size of hospitals. First, Banker et al. Weaver and Deolalikar [84] investigated the performance (economies of scale and scope) of Vietnamese public hospitals using a sample composed of general, specialty, district and ministry hospitals. The Effect of market and organizational structure on hospitals’ efficiency was analysed by Ancarani et al. First, Hefty [8] reviewed the progress made in the study of economies of scale in hospitals, finding that the long-term average cost curve appears to be U-shaped, with minimum average costs at the level of 200–300 beds. Such services have a significant weight in total hospital costs; a proper analysis of their cost structure is important. Generally, authors showed that concentrating health services in city centres does have negative implications for efficiency. According to the results, the authors found that small hospitals tend to be more efficient, whereas large hospitals tend to be less efficient [30]. In another study, the author used a questionnaire sent to a hospital to explore responses to the merger of the hospital [46]. Patients belonging to the telehealth appointment group at Strasbourg's teaching hospital (n = 97) experienced a decrease in their HbA 1c average from 7.65 ± 1.19% to 7.18 ± 0.9%, while patients from the same group attending a private medical office (n = 78) also experienced a decrease from 7.28 ± 0.80% to 7.11 ± 0.79%. In contrast, other authors [91, 92] who explored the efficiency of hospitals observed that larger hospitals displayed higher cost efficiency, higher allocative efficiency and higher technical efficiency than did their smaller counterparts. Conversely, if you work at a small, rural hospital… The average hospital needs roughly 2,500sq.ft. Studies analysed in this review showed that economies of scale are present for merging hospitals. The initial results revealed several articles without direct connection to the precise review requirements because the review located all articles that contained the words “scale efficiency”, “hospital beds”, “mergers”, “economies of scale” or “hospital size”. However, most authors found that large hospitals (over 300 beds) might have a greater potential for … 1072 0 obj <>stream Using index and direct approaches, the authors examined a variety of potential reconfigurations and found that there were indeed large-scale unexploited gains achievable from strategic consolidation in the hospital sector. They confirmed what was said in the previous fields: economies of scale are evident for hospitals with 200–300 beds. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 1020 0 obj <> endobj We could differentiate rural hospitals and urban hospitals. The same conclusion was drawn for Chinese hospitals [58]. For example, Suraratdecha and Okunade [54] investigated the economic relationship among medical resources and efficiency of the health care system in a developing Asian country. The estimated average hospital bill size includes ward charges, treatment fees, therapy charges and ancillary charges such as simple in-house investigations, procedures and standard medications. Discover a faster, simpler path to publishing in a high-quality journal. The presence of a large number of empirical studies might be explained by the nature of the topic analysed in this paper. Conversely, larger size does not automatically confer "average" status on a hospital. In the USA, the early 1990s could also be labelled a restructuring era for health care systems. Concerning quantitative methods, most of the articles employed DEA analysis to test technical and scale efficiencies in the hospital sector (34%). A random sample of recent hospital stays for both men and women revealed the following. However, Posnett [82] discussed the existence of gains in terms of economies of scale in large hospitals, concluding that evidence from research did not support any general presumption that larger hospitals benefit from economies of scale or that service concentration leads to improved outcomes for patients. Concerning HMOs, a study found that HMOs with Medicaid patients are significantly less efficient than are other HMOs [59]. Finally, Cohen and Morrison Paul [28] evaluated scale, scope and agglomeration economies for Washington State hospitals from 1997 to 2002. The authors explored the cost structure of Swiss hospitals, focusing on differences due to teaching activities and differences related to ownership and subsidization types. Moreover, teaching hospitals were generally more efficient than non-teaching hospitals [77]. Concerning location, most of the articles (58%) included rural and urban hospitals in their analyses, and 19 articles did not specify the hospital location (42%). Concerning quantitative methods, the most frequently used analysis technique is DEA (50%). https://doi.org/10.1371/journal.pone.0174533.t015. In two studies, non-specified hospital types constituted the sample (8%). Specifically, productivity growth was primarily due to technical and scale efficiency changes rather than from technological change. Based on these rules, in the first phase of the selection process, we selected 131 papers and excluded 2.093.211 papers. In this case, it is necessary to address the question of “economies/diseconomies of scale”. endstream endobj startxref Setting. Second, Finkler [49] reviewed and reconciled articles concerning the industry's long-term average cost curve, concluding that large hospitals (over 300 beds) might have a greater potential for scale economies. Wha level hospital it is graded at being 1 through 6. The increase in the number of patients with very short lengths of stay, particularly those admitted as emergencies, has contributed to this reduction ( Poteliakhoff and Thompson 2011 , p3). Table 4 shows the frequency distribution of articles on efficiency published in Business and Economic journals by research topic in a hospital setting. This consideration justifies the keywords for our search. https://doi.org/10.1371/journal.pone.0174533.t001. [86] used DEA to calculate technical and scale efficiency scores of a sample of China’s county hospitals. Hospital Name City Staffed Beds Total Discharges Patient Days Gross Patient Revenue ($000) Baylor Scott & White Medical Center Plano: Plano: 118: 6,777: 31,742 Ai 2020a. Bed size 50 to 99: 264 67. In particular, the author estimated a stochastic frontier cost function to test for inefficiency differences among system hospitals having common strategic and/or structural characteristics. Most of the studies in this area were concentrated in the period 1990–2000. � ��MoL � ? https://doi.org/10.1371/journal.pone.0174533.t018. Author information: (1)Center for Pharmacoeconomic Research and Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago (UIC) 60612, and Saint Clare's Hospital, Denville, NJ, USA. When the existing number of beds is in excess of that required for efficient inpatient service provision, total beds could be reduced, thus producing the same output at lower cost [20]. This paper analyses the stance of existing research on scale efficiency and optimal size of the hospital sector. This translates to about $96,000 per year but it may vary from one hospital to another. This macro category included the following topics: Effect of healthcare reforms, managerial aspects and ownership on hospital efficiency. Posted November 18, 2016. Another relevant contribution was provided by Farsi and Filippini [42]. Hospital size and primary language (non–English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. https://doi.org/10.1371/journal.pone.0174533.t003. Total hospital beds include curative (or acute) care beds, rehabilitative care beds, long-term care beds and other beds in hospitals. In addition we provided physician practice compensation and publicly owned hospitals. Finally, Masiye [16] estimated technical and scale efficiencies of a sample of hospitals in Zambia by collecting data from the official database of the Ministry of Health and direct visits to individual’s hospital. N.: number. Hospital cost Efficiency, or analysis of potential cost gains arising from hospital mergers. To overcome limits related to the choice and use of a single database, we integrated papers on the topic by using the Google search engine; the search returned 2.070.501 papers. Most articles investigated on these topics using a sample of General/Acute-care Hospitals (47%). The highest number of articles (3) was found in the Social Science & Medicine journal (SSM). https://doi.org/10.1371/journal.pone.0174533.t008. Size – >2280X1600X2300 mm with door size >1300X2100 mm. Our analysis is necessarily limited to publicly available papers and thus potentially subject to publication bias. lillyhospitalsurvey.ca. 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 [, Many factors influence scale efficiency level [, Concerning methods, many works on scale efficiency were empirical studies, given the nature of this topic. Most of these studies argued that larger hospitals benefit from the exploitation of economies of scale. Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy. In these countries, the incorporation of hospitals and horizontal integration through the creation of holding companies or hospital networks under private law was a viable tool to combine market incentives for management while maintaining public ownership and at the same time achieving efficiency gains and economies of scale. In addition, only papers published in English language were reviewed which means that findings from data published in other languages were automatically excluded from the review. The paper investigated the effect of market structure on the technical efficiency of hospitals, decomposed into pure technical and scale efficiency. In this section, we analyse studies on scale efficiency in the hospital sector published by Medicine journal. Concerning hospitals ownership, over half of the articles included only public hospitals (67%); only 3 articles considered public and private hospitals (25%), and only one article failed to specify hospital ownership (8%). For an initial discussion about the survey results it could be useful to try connecting academic fields. The largest number of records in early rounds of searching factor and that realize... Better supplied with resources than are other HMOs [ 59, 61, 64 ] Rà mirez et al merging! 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