Thursday, 21 March 2013

Merger mania Seven



Now we know that all those closures cost a lot of money and then after a while it got worse, they lost even more money.

Surely, quality must have gone up – that’s what it was all about. The italics are mine, the rest are quotes from the report;


“ Waiting times, length of stay and quality indicators

Table 3 presents results for a large set of measures that have been used as indicators of quality of patient care. We begin by examining waiting time and length of stay. We then examine measures of quality of clinical care published by the national agency which constructs measures of clinical quality of care.

In the main, none of these measures show an improvement and there are some signs of a decrease in quality of care. Column (1) shows no effect of merger on length of stay. Columns (2) and (3) present some evidence of an increase in both mean waiting times and of the share of patients waiting more than 180 days for an elective admission four years post merger.”

Wait a minute, length of hospital stay was the same and waiting times got worse?

“In terms of the clinical measures, we examine death rates from emergency heart attack (AMI) admissions, a widely used measure in the literature on the impact of market configuration on outcomes (e.g. Kessler and McClellan, 2000), measures of care for patients with stroke and measures of care for patients with fractured proximal femur. For AMI (column 4) and fractured proximal femur (columns 8 - 10) the quality indicators remain relatively stable post merger. However, columns (5) and (6) show poorer outcomes for patients admitted following a stroke. Column (5) shows higher death rates post discharge after merger. Column (6) shows higher readmission rates to hospital within 28 days of discharge, both immediately before the merger and post-merger. Column (7) shows an improvement in one measure – the 56 day return rate to usual place of residence - but this is for only one of the years post-merger and is only significant at 10%.”

Now this is bad;

Heart attacks and broken femurs no change.

Strokes – death rates get worse after merger – probably because there is more delay in getting treated because the nearest Hospital is now further away.

Higher death rates after being discharged.

Higher readmission rates within 28 days.

The only thing that got better was the Hospitals ability to kick patients out early, often too early, and that only got better in only one of the years examined.


“In summary, we find that whilst the effect of mergers was to shrink the combined size of the merged hospitals, other than this reduction in size and associated fall in activity, the merger does not appear to have brought benefits. Labour productivity does not appear to have risen, the merger has not stemmed the increases in size of deficits and there are no indications of an increase in quality (in fact there is one indicator of a fall in measures of clinical care.”

That means it was all a waste of time as well as money? And then things got worse.

That can’t be right. I’ll wrap it up tomorrow.



Neil Harris

(a don’t stop till you drop production)

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