One study used a mixed sample (4%) composed of teaching, base, small general, country, maternity, geriatric, psychiatric and maternity hospitals [23]. 1072 0 obj <>stream Investigating the operating efficiencies of merged and control hospitals prior to and after the merger, some authors [45] showed that hospital merger activity reduced the cost of production by achieving scale and scope economies, allowing hospitals to become more efficient. The author presented one survey of empirical studies concerning economies of scale and hospital costs from 1952 to 1969, finding that the long-term average cost curve appears to be U-shaped, with minimum average costs at the level of 200–300 beds. The total of initial records was 2.093.342 papers. There is no set standard in western hospitals. Yes They concluded that economies of scale and scope depend upon the category of the hospital in addition to the number of beds and volume of output. The average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. From studies published in Medicine journals it was possible to draw interesting conclusions about the relationship between volumes and outcomes. They also confirmed that the economies of scale are greater when the new entity has a number of beds between 250 and 300, and with less than 10,000 annual discharges. Technical and scale efficiencies of a sample of Italian hospitals were comparatively examined before and after a reform to control health expenditures [37]. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds. 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. Hospitals, beds, and occupancy rates, by type of ownership and size of hospital: United States, selected years 1975–2009 [Data are based on reporting by a census of hospitals] Type of ownership 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%). If you toil at a big urban hospital, your sphere of interest encompasses GME, training, research, and safety net care. 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). Hospital inpatients a. These rules are not hard and fast, but they serve as a starting point for the planning phase of the project. Daidone and D’amico [38] analysed the effect of productive structure and level of specialization of hospital on technical efficiency using the Cobb-Douglas function and the Stochastic Frontier Model. Four studies employed Mixed methods (15%). Table 16 shows the frequency distribution of articles published in Medicine journals by primary data analysis technique. Additionally, the study used Tobit Analysis to estimate cost, technical, allocative and scale efficiencies of public and private hospitals. Data synthesis involved a descriptive summary of included studies, as in the following sections. The paper is organized as follows. In the next section, a description of the search strategy is provided. Concerning mixed methods, most of the articles were descriptive/empirical studies (10); six articles were theoretical/descriptive studies and four articles were theoretical/descriptive and empirical studies.