Hospital volume and health care outcomes, costs and patient access

NHS Centre for Reviews and Dissemination
Record ID 31999008318
Authors' objectives:

This report summarises the results of systematic reviews carried out at the University of York to assess research into the possible relationship between volume of clinical activity in hospitals and the quality of health care outcomes, hospital costs and patient access. It aims to inform decision makers facing choices about the configuration of services such as rationalisation or Trust mergers where concentration of hospital services in to larger hospitals has been proposed as a means of improving the quality of health care.

Authors' recomendations: 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.
Authors' methods: Systematic review
Project Status: Completed
Year Published: 1996
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England
MeSH Terms
  • Costs and Cost Analysis
  • Hospital Charges
  • Quality of Health Care
  • Hospitals
Organisation Name: University of York
Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,
Contact Name:
Contact Email:
Copyright: Centre for Reviews and Dissemination
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.