One article did not specify data sources. Five studies did not specify the hospital type included in the sample according to service offered (22%). There has been a particularly large increase in research on the topic in recent years due to the massive process of health integration and to the interest in finding an optimal size for hospitals as a reply to worldwide policies of financial constraint, which has led to greater public attention to the use of public resources. Posted November 18, 2016. Weaver and Deolalikar [84] analysed economies of scale using a sample of 654 public Vietnamese hospitals. In conclusion, our systematic search started with 4 search questions: According to this literature review it is possible to answer these questions in the following way: https://doi.org/10.1371/journal.pone.0174533.t022. An urban hospital is generally located in a metropolitan area and serves a large range of people. Most of these studies argued that larger hospitals benefit from the exploitation of economies of scale. In order to reduce the selection bias three members of the research team reviewed the titles, abstracts, and keywords of all records, which were retrieved separately, to determine whether the studies met the inclusion criteria. Oliveira and Bevan [98] used a hierarchical fixed effects model and a multi-level random intercepts and slopes model to investigate technical efficiency for a sample of hospitals. Hospitals’ inefficiency reflected the revenue-based behaviour of hospitals in which unnecessary care, over-prescription of drugs, and the adoption of high-tech treatments were commonly found. The global hospital information systems market size was valued at USD 13.26 billion in 2015 and is projected to grow at a CAGR of 11.4% during the forecast period. An important contribution concerning hospital size was made by Tsai and Jha [85]. Length of Hospital Stays The average length of "short hospital stays" for men is slightly longer than that for women, 5.2 days versus 4.5 days. However, at some point, a hospital departs from its optimal level of efficiency and begins to exhibit diseconomies of scale. Concerning quantitative methods, DEA analysis was preferred (61%). here. Further complicating policymakers' ability to assess hospital pharmacy department productivity and efficiency is the large variation in the size of hospitals in the United States. Constant returns to scale also prevailed in Greek public hospitals [62, 63] and in Washington State hospitals in 1988–1993 [64]. A consolidated firm may be capable of realizing lower costs for a given quantity and quality of services by exploiting economies of scale and scope. In a first stage, the authors discussed theoretically the question under analysis (hospital mergers, potential gains from the mergers and other topics). 2) Which is the optimal size of hospitals in terms of beds? In particular, authors concluded that there is no evidence that the increase in size may lead to outcome improvements. The classic hospital beds are also called curative beds. https://doi.org/10.1371/journal.pone.0174533.t010. The total of initial records was 2.093.342 papers. Specifically, 14 articles included in their analysis government and non-government hospitals. For severe patients with risk of organ(s) failure, patients are provided intensive care unit beds (aka ICU bed) or critical care beds (CCB). They concluded that economies of scale and scope depend upon the category of the hospital in addition to the number of beds and volume of output. One study investigated efficiency effect of health reforms. [2] assessed technical and scale efficiency and productivity changes of public municipal hospitals in Angola. The authors concluded that in the context of health care reform, mergers might offer an expeditious means to restructure health services locally. Most of the articles were published by JPA or AE. By Mariana Romero Roy. The authors found the existence of economies of scale and scope. The identification of the search strategy has required the definition of a series of aspects concerning the findings process, as illustrated below. According to this rule, we eliminated 26 papers. lillyhospitalsurvey.ca. Many articles discussed the effect of health reforms on a hospital’s efficiency. Journals publish material relevant to any aspect of health from a wide range of social science disciplines and relevant material concerning issues of health, health care, clinical practice, health policy and organization. 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