Hospital volume and health care outcomes, costs and patient access

- There are some pressures for acute services to be concentrated in hospitals with larger volume.
- Much research examining the relationship between hospitals or clinician volume and health outcomes is of poor quality and does not make adequate adjustment for differences in patient case-mix.
- The best research suggests that there is no general relationship between volume and quality. However, in some specialities there appear to be quality gains associated with increased hospital or clinician volume.
- There is no evidence that cost savings can be secured merely by increasing scale in acute hospitals beyond 200 beds and it is likely that large hospitals (above 600 beds) display diseconomies of scale, though these inefficiencies may be offset in other
ways.
- There is evidence that utilisation of some health services is lower for patients living further away. When services are concentrated, some of the costs are shifted from the health service to patients and their carers