ReviewPloS one2017
Efficiency and optimal size of hospitals: Results of a systematic search.
Review in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Impact of hospital mergers: a systematic review focusing on healthcare quality measures.European journal of public health · 2022Pooled it
- A systematic review on hospital inefficiency in the Eastern Mediterranean Region: sources and solutions.BMC health services research · 2019Pooled it
- A Systematic Literature Review of Efficiency Measurement in Nursing Homes.International journal of environmental research and public health · 2019Pooled it
- Impact of Digitalization on Performance of Dutch Hospitals: Longitudinal Quantitative Study.Journal of medical Internet research · 2026Observational
- Evaluation of the efficiency of county-level medical and health services under the background of county medical community policy: a case study of Sanming, China.Health economics review · 2026Article
- Capacity Planning for Small Hospitals and Departments Illustrated Using Maternity and Paediatrics Departments: Roles for Weighted Population Density, Seasonality and Size, Myths Around Length of Stay and Factors Influencing Costs and Funding.International journal of environmental research and public health · 2026Article
- iCardio: Applying Business Intelligence to Assess Regional Disparity in Cardiovascular Care with Real-World Data.Arquivos brasileiros de cardiologia · 2026Article
- Scale, Skill-Mix, and Access Implications of the Production of Appointments by Primary Care Practices in England.Health economics · 2026Article
- Between-Hospital Variation in Failure to Rescue After Major Surgery.JAMA network open · 2026Article
- Fragmentation in health system financing: a major challenge for improving effectiveness, efficiency, equity and choice within health systems.BMJ public health · 2026Review
- Technology Readiness Drives Digital Adoption in Dentistry: Insights from a Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2025Article
- The Future Hospital in Global Health Systems: The Future Hospital Within the Healthcare System.The International journal of health planning and management · 2025Review
- Economies of scope in the Norwegian public hospital sector.The European journal of health economics : HEPAC : health economics in prevention and care · 2025Article
- Identifying and prioritizing inefficiency causes in Iran's health system.Cost effectiveness and resource allocation : C/E · 2024Article
- Association between characteristics of employing healthcare facilities and healthcare worker infection rates and psychosocial experiences during the COVID-19 pandemic.BMC health services research · 2024Article
- Analyzing risk factors for post-acute recovery in older adults with Alzheimer's disease and related dementia: A new semi-parametric model for large-scale medicare claims.Statistics in medicine · 2024Article
- Hospital and Patient Factors Affecting Veterans' Hospital Choice.Medical care research and review : MCRR · 2024Article
- Motif discovery in hospital ward vital signs observation networks.Network modeling and analysis in health informatics and bioinformatics · 2024Article
- Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System.International journal of environmental research and public health · 2023Review
- Efficiency and Resource Allocation in Government Hospitals in Saudi Arabi: A Casemix Index Approach.Healthcare (Basel, Switzerland) · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNational Health Systems managers have been subject in recent years to considerable pressure to increase concentration and allow mergers. This pressure has been justified by a belief that larger hospitals lead to lower average costs and better clinical outcomes through the exploitation of economies of scale. In this context, the opportunity to measure scale efficiency is crucial to address the question of optimal productive size and to manage a fair allocation of resources. METHODS AND
findingsThis paper analyses the stance of existing research on scale efficiency and optimal size of the hospital sector. We performed a systematic search of 45 past years (1969-2014) of research published in peer-reviewed scientific journals recorded by the Social Sciences Citation Index concerning this topic. We classified articles by the journal's category, research topic, hospital setting, method and primary data analysis technique. Results showed that most of the studies were focussed on the analysis of technical and scale efficiency or on input / output ratio using Data Envelopment Analysis. We also find increasing interest concerning the effect of possible changes in hospital size on quality of care.
conclusionsStudies analysed in this review showed that economies of scale are present for merging hospitals. 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. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.