Concentration and choice in the provision of hospital services

Centre for Health Economics; York Health Economics Consortium; NHS Centre for Reviews and Dissemination
Record ID 31999008334
Authors' objectives:

This report is divided into three parts:

Part I: The relationship between hospital volume and quality of health outcomes

Part II: The relationship between volume and the scope of activity and hospital costs

Part II: The relationship between concentration, patient accessibility and utilisation of services

Authors' recommendations: These reports conclude: much research over-estimates the impact of volume on the quality of care; there is no clear link between hospitals carrying out larger volumes of surgical procedures and having better outcomes; there is no evidence that cost savings are necessarily made by increasing hospital size above approximately 200 beds; concentrating services may reduce access to hospital care for patients living further away, particularly those who are older and poorer; experience shows that hospital mergers do not always result in the financial benefits that were initially anticipated. Decision makers considering concentrating services should be cautious in making assumptions about health care and financial benefits which can be derived from increasing the size of units. Such assumptions are often based more on received wisdom rather than research evidence.
Authors' methods: Systematic review
Project Status: Completed
Year Published: 1997
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England
MeSH Terms
  • Cost Savings
  • Health Facility Merger
  • Health Facility Size
  • Hospital Costs
  • Outcome Assessment, Health Care
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.