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Is it better to be big?: The reconfiguration of 21st century hospitals: Responses to a hospital merger in Sweden

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  • Ahgren, Bengt

Abstract

Objectives Swedish hospital mergers seem to stem from a conviction among policy makers that bigger hospitals lead to lower average costs and improved clinical outcomes. The effects of mergers in the form of multisited hospitals have not been systematically evaluated. The purpose of this article is to contribute to this area of knowledge by exploring responses to the merger of Blekinge Hospital.Methods The evaluation was guided by the philosophy of triangulation. A questionnaire was sent to 597 randomly selected employees, that is 24% of the health care staff. Four hundred ninety-eight employees answered the questionnaire, giving a response rate of 83%. Furthermore, interviews of different groups of stakeholders were conducted.Results A moderate increase of quality was assessed, which, a low proportion of the employees perceived had decisively or largely to do with the merger. The majority perceives economical incentives as the drivers of change, but, at the same time, only 10% of this group believes this target was reached completely or to a large extent.Conclusions The employees believe the merger has neither generated economy of scale advantages nor substantial quality improvement. Instead, it seems more rewarding to promote cross-functional collaboration together with clinical specialisation. Needs for both integration and differentiation could thereby be fulfilled.

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  • Ahgren, Bengt, 2008. "Is it better to be big?: The reconfiguration of 21st century hospitals: Responses to a hospital merger in Sweden," Health Policy, Elsevier, vol. 87(1), pages 92-99, July.
  • Handle: RePEc:eee:hepoli:v:87:y:2008:i:1:p:92-99
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    1. Sheps, S.B. & Reid, R.J. & Barer, M.L. & Krueger, H. & McGrail, K.M. & Green, B. & Evans, R.G. & Hertzman, C., 2000. "Hospital Downsizing and Trends in Health Care Use Among Elderly People in British Columbia," Centre for Health Services and Policy Research 2000:10, University of British Columbia - Centre for Health Services and Policy Research..
    2. Liu, Liyan & Hader, Joanne & Brossart, Bonnie & White, Robin & Lewis, Steven, 2001. "Impact of rural hospital closures in Saskatchewan, Canada," Social Science & Medicine, Elsevier, vol. 52(12), pages 1793-1804, June.
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    1. Javier Cerezo-Espinosa de los Monteros & Antonio Castro-Torres & Juan Gómez-Salgado & Javier Fagundo-Rivera & Carlos Gómez-Salgado & Valle Coronado-Vázquez, 2021. "Administration of Strategic Agreements in Public Hospitals: Considerations to Enhance the Quality and Sustainability of Mergers and Acquisitions," IJERPH, MDPI, vol. 18(8), pages 1-18, April.
    2. Monica Giancotti & Annamaria Guglielmo & Marianna Mauro, 2017. "Efficiency and optimal size of hospitals: Results of a systematic search," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-40, March.
    3. Kristensen, Troels & Olsen, Kim Rose & Kilsmark, Jannie & Lauridsen, Jørgen T. & Pedersen, Kjeld Møller, 2012. "Economies of scale and scope in the Danish hospital sector prior to radical restructuring plans," Health Policy, Elsevier, vol. 106(2), pages 120-126.
    4. Garcia-Lacalle, Javier & Martin, Emilio, 2010. "Rural vs urban hospital performance in a 'competitive' public health service," Social Science & Medicine, Elsevier, vol. 71(6), pages 1131-1140, September.
    5. Leo Cazin, 2016. "Can French public hospitals make do with a dynamic and uncertain environment by developing inter-organizational restructuration strategies?," Post-Print hal-01295204, HAL.
    6. John K. Christiansen & Morten Wellendorf, 2021. "Exploring Opportunities with Experimental Use of Communicative Spaces to Overcome Defensive Routines and Increase Information Systems Utilization," Systemic Practice and Action Research, Springer, vol. 34(6), pages 713-750, December.

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