Is there a volume-quality relationship within the independent treatment centre sector? A longitudinal analysis

Abstract

BackgroundThe number of independent treatment centres (ITCs) has grown substantially. However, little is known as to whether the volume-quality relationship exists within this sector and whether other possible organisational factors mediate this relationship. The aim of this study is to gain a better understanding of such possible relationships.MethodsData originate from the Dutch Health and Youth Care Inspectorate (IGJ) and the Dutch Patients Association. We used longitudinal data from 4 years (2014–2017) including three different quality measures: 1) composite of structural and process indicators, 2) postoperative infections, and 3) patient satisfaction. We measured volume by the number of invasive treatments. We adjusted for three important organisational characteristics: (1) size of workforce, (2) chain membership, and (3) ownership status. For statistical inference, random effects analysis was used. We also ran several robustness checks for the volume-quality relationship, including a fractional logit model.ResultsITCs with higher volumes scored better on structure, process and outcome (i.e. postoperative infections) indicators compared to the low-volume ITCs – although only marginally on outcome. However, ITCs with higher volumes do not have higher patient satisfaction. There is a decreasing marginal effect of volume – in other words, an L-shaped curve. The effect of the intermediating structural factors on the volume-quality relationship (i.e. workforce size, chain membership and ownership status) is less clear. Our findings suggest that chain membership has a negative influence on patient satisfaction. Furthermore, for-profit providers scored better on the Net Promoter Score.ConclusionsOur study shows with some certainty that the quality of care in low-volume ITCs is lower than in high-volume ITCs as measured by structural, process and outcome (i.e. postoperative infection) indicators. However, the size of the effect of volume on postoperative infections is small, and at higher volumes the marginal benefits (in terms of lower postoperative infections) decrease. In addition, volume is not related to patient satisfaction. Furthermore, the association between the structural intermediating factors and quality are tenuous.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-4467-5) contains supplementary material, which is available to authorized users.

Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands – A Study of 5 Elective Surgeries

“… 50 , 52 - 54 One contribution from the United States and the Netherlands shows that the volume-quality relationship also persist within the ITC sector, however, this relationship appears to be weaker. 51 , 55 Different from the previous studies, our results do not indicate that a volume-quality relationship exists for the 5 treatments included in this study.…”

“…The volume-quality relationship has been demonstrated in previous research on high-risk surgical procedures in hospitals, [44][45][46][47][48][49] but is less studied for low-risk surgical outpatient procedures. 50,51 Previous research has demonstrated that high-volume hospitals provided better quality of care for low-risk invasive treatments. 50,[52][53][54] One contribution from the United States and the Netherlands shows that the volume-quality relationship also persist within the ITC sector, however, this relationship appears to be weaker.…”

Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a community-based, cross-sectional study

“…Both these factors could have contributed to a negative patient experience and influenced their perception of overall quality of care. Some studies reported a positive relationship between patient volume and quality of basic maternal care, and postoperative infections 52 53. The alternative direction of this relationship, in which quality drives patient volume, is based on the assumption that the provision of high-quality care will attract more patients.…”

Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a multilevel analysis

“…Some studies reported a positive relationship between patient volume and quality of basic maternal care, and postoperative infections. 51 52 The alternative direction of this relationship, in which quality drives patient volume, is based on the assumption that the provision of high-quality care will attract more patients. This may be true in areas where patients have access to competitive health care facilities, and health care providers are incentivized for providing higher quality care.…”