Are acute hospital trust mergers associated with improvements in the quality of care?

IF 1.7 4区医学 Q3 HEALTH POLICY & SERVICES

Journal of Health Organization and Management Pub Date : 2024-10-22 DOI:10.1108/JHOM-09-2023-0268

James Beveridge, David G Lugo-Palacios, Jonathan Clarke

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引用次数: 0

Abstract

Purpose: This study aims to assess the extent to which acute hospital trust mergers in England are associated with quality improvements.

Design/methodology/approach: We apply an event study design using difference-in-difference (DID) and coarsened exact matching to compare the before-and-after performance of eight mergers from 2011 to 2015.

Findings: We find little evidence that mergers contribute to quality improvements other than some limited increases in the proportion of patients waiting a maximum of 18 weeks from referral to treatment. We postulate that financial incentives and political influence could have biased management effort towards waiting time measures.

Research limitations/implications: Inherent sample size constraints may limit generalisability. Merger costs and complexity mean they are unlikely to offer an efficient strategy for helping to clear elective care backlogs. We recommend further research into causal mechanisms to help health systems maximise benefits from both mergers and emerging models of hospital provider collaboration.

Originality/value: This paper is the first to study the quality impact of a new wave of acute hospital mergers taking place in the English National Health Service from 2011 onwards, applying a group-time DID estimator to account for multiple treatment timings.

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急症医院托管机构的合并是否与医疗质量的提高有关？

目的：本研究旨在评估英格兰急症医院托管机构合并与质量改善的关联程度：我们采用差分法（DID）和精确匹配法进行事件研究设计，比较了 2011 年至 2015 年期间八家医院合并前后的表现：我们发现，除了从转诊到接受治疗最多需等待 18 周的患者比例有所上升外，几乎没有证据表明合并有助于提高质量。我们推测，经济激励和政治影响可能会使管理层偏向于采取缩短候诊时间的措施：固有的样本量限制可能会限制研究的普遍性。合并的成本和复杂性意味着它们不太可能提供有效的策略来帮助清除择期治疗的积压。我们建议进一步研究因果机制，以帮助医疗系统从兼并和新兴的医院供应商合作模式中获得最大收益：本文首次研究了自 2011 年起在英国国民健康服务中发生的新一轮急症医院合并对医疗质量的影响，并采用了分组时间 DID 估计法来考虑多种治疗时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Health Organization and Management HEALTH POLICY & SERVICES-

CiteScore

3.20

自引率

7.10%

发文量

期刊介绍： ■International health and international organizations ■Organisational behaviour, governance, management and leadership ■The inter-relationship of health and public sector services ■Theories and practices of management and leadership in health and related organizations ■Emotion in health care organizations ■Management education and training ■Industrial relations and human resource theory and management. As the demands on the health care industry both polarize and intensify, effective management of financial and human resources, the restructuring of organizations and the handling of market forces are increasingly important areas for the industry to address.