Health Care; Productivity; Economies of Scale; Economies of Scope; Spillovers; Econometrics
General hospitals across the world are becoming larger (i.e. admitting more patients each year) and more complex (i.e. offering a wider range of services to higher acuity patients with more diverse care needs). Although prior work has shown that increased volume is positively associated with patient outcomes, it is less clear how volume affects costs in these complex organizations.This paper investigates this relationship using panel data for 15 specialties comprising both elective and emergency admissions across 157 hospitals in England over a period of ten years. Although the authors find significant economies of scale for both elective and emergency admissions, the authors also find evidence of negative spillovers across the two admission categories, with increased elective volume at a hospital being associated with an increase in the cost of emergency care.Furthermore, for emergency admissions, the authors find evidence of positive spillovers across specialties - increased emergency activity in one specialty is associated with lower costs of emergency care in other specialties. By contrast, the authors find no evidence of such spillovers across specialties for elective admissions.The authors’ findings have implications for individual hospital growth strategies and for the regional organization of hospital systems.