Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

Blank, Jos L. T.; Hulst, B.L. Van; Valdmanis, Vivian

doi:10.1002/hec.3409

Cited by 9 publications

(8 citation statements)

References 11 publications

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“…This nding implies that marginal costs contribute sizeably to the total cost of EC care; as such, economies of scale -where unit cost decreases as the volume of output increases -may not be as signi cant to EC care interventions as previously suggested. 37 This nding aligns with current evidence of the higher than expected marginal costs of outpatient EC in HIC. 11 These ndings hint that a further cost saving may be realized if additional reuse of supplies is promoted where reasonable.…”

Section: Discussionsupporting

confidence: 82%

The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study

Werner

Lin

Risko

et al. 2020

Preprint

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BACKGROUNDUganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions.METHODSA direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions.RESULTS872 patient cases were captured with an overall median cost of care of $15.17 USD ($14.08 to $18.85). The median cost per condition was highest for post-partum haemorrhage at $16.87 ($14.66 to $20.99), followed by road traffic injuries at $15.59 ($14.15 to $19.93), asthma at $15.53 ($14.39 to $18.87), pneumonia at $15.18 ($14.28 to $19.72), and paediatric diarrhoea at $14.25 ($13.38 to $15.20). The median cost per intervention was highest for fracture reduction and splinting at $27.41 ($21.63 to $31.14). Cost values differ between sentinel conditions (p <0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p<0.05).CONCLUSIONThis study is the first to describe the direct costs of EC in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.

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Section: Discussionsupporting

confidence: 82%

The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study

Werner

Lin

Risko

et al. 2020

Preprint

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“…Discounting of capital costs resulted in very minimal changes to results with median economic costs being 2.4% higher than median accounting costs. This finding implies that marginal costs contribute sizeably to the total cost of EC care; as such, economies of scale – where unit cost decreases as the volume of output increases – may not be as significant to EC care interventions as previously suggested [ 37 ]. This finding aligns with current evidence of the higher than expected marginal costs of outpatient EC in HIC [ 12 ].…”

Section: Discussionmentioning

confidence: 73%

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

Werner

Lin

Risko

et al. 2021

BMC Health Serv Res

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Background Uganda experiences a high morbidity and mortality burden due to conditions amenable to emergency care, yet few public hospitals have dedicated emergency units. As a result, little is known about the costs and effects of delivering lifesaving emergency care, hindering health systems planning, budgeting and prioritization exercises. To determine healthcare costs of emergency care services at public facilities in Uganda, we estimate the median cost of care for five sentinel conditions and 13 interventions. Methods A direct, activity-based costing was carried out at five regional referral hospitals over a four-week period from September to October 2019. Hospital costs were determined using bottom-up micro-costing methodology from a provider perspective. Resource use was enumerated via observation and unit costs were derived from National Medical Stores lists. Cost per condition per patient and measures of central tendency for conditions and interventions were calculated. Kruskal-Wallis H-tests and Nemyeni post-hoc tests were conducted to determine significant differences between costs of the conditions. Results Eight hundred seventy-two patient cases were captured with an overall median cost of care of $15.53 USD ($14.44 to $19.22). The median cost per condition was highest for post-partum haemorrhage at $17.25 ($15.02 to $21.36), followed by road traffic injuries at $15.96 ($14.51 to $20.30), asthma at $15.90 ($14.76 to $19.30), pneumonia at $15.55 ($14.65 to $20.12), and paediatric diarrhoea at $14.61 ($13.74 to $15.57). The median cost per intervention was highest for fracture reduction and splinting at $27.77 ($22.00 to $31.50). Cost values differ between sentinel conditions (p < 0.05) with treatments for paediatric diarrhoea having the lowest median cost of all conditions (p < 0.05). Conclusion This study is the first to describe the direct costs of emergency care in hospitals in Uganda by observing the delivery of clinical services, using robust activity-based costing and time motion methodology. We find that emergency care interventions for key drivers of morbidity and mortality can be delivered at considerably lower costs than many priority health interventions. Further research assessing acute care delivery would be useful in planning wider health care delivery systems development.

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“…Since the transition point in the function of LMC happens with the smaller quantities of produced output, such as the quantities in which the line from the coordinate starting point reaches its position as the tangent to the function of LAC, the minimum value of the function of LMC is with the smaller quantities of output than the minimum value of LAC. Several other authors have similar experiences (Blank et al, 2017;Mukamel et al, 2014). The graph of the curve of LMC shows that the function of LMC reaches its minimum at approximately 125,000 patients per year.…”

Section: Resultsmentioning

confidence: 73%

“…If all the factors are increased, then certain scales -in our case they are called returns of scale -spring up as a direct result. They are composed of the so-called economies and diseconomies of scale (Blank et al, 2017;Hernandez-Villafuerte et al, 2017). Economies of scale are a consequence of realising that LAC decrease if we increase all the production factors (Kristensen et al, 2012).…”

Section: Efficiency and Optimal Size Of Healthcare Providers -Literatmentioning

confidence: 99%

Estimating the optimal size of secondary healthcare providers in Slovenia

Blatnik

Bojnec

2019

IJSE

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One of the fundamental problems of healthcare systems is how to ensure efficient performance of secondary healthcare providers. Economic efficiency is related to the volume of production therefore, one of the remaining key issues is the optimal size of secondary healthcare providers. The chief goal of our study was to determine the most typical form of long-term cost function and the optimal size of secondary healthcare providers in Slovenia. Our results show that hospitals would function with the lowest possible costs per one unit of output when treating between 188,000 and 243,000 patients annually. The average price of an individual service should be set above the minimum of long-term average costs, indicating that a general hospital is of the optimal size when treating between 246,000 and 275,000 patients annually. Expert knowledge on different types of long-term costs and service prices can be a useful tool for any hospital management. The estimations provided by our study can be usefully employed by management teams of general hospitals primarily during the decision-making processes regarding future business operations.

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Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

Cited by 9 publications

References 11 publications

The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study

The Costs of Delivering Emergency Care at Regional Referral Hospitals in Uganda: A Micro-Costing Study

The costs of delivering emergency care at regional referral hospitals in Uganda: a micro-costing study

Estimating the optimal size of secondary healthcare providers in Slovenia

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