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What underlies the observed hospital volume- outcome relationship?

Author

Listed:
  • Marius Huguet

    (CIS - MINES - Centre Ingénierie Santé, Saint-Étienne, Centre Léon Bérard [Lyon])

  • Xavier Joutard

    (LEST - Laboratoire d'Economie et de Sociologie du Travail - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique, OFCE - Observatoire français des conjonctures économiques (Sciences Po) - Sciences Po - Sciences Po)

  • Isabelle Ray-Coquard

    (Centre Léon Bérard [Lyon])

  • Lionel Perrier

    (GATE Lyon Saint-Étienne - Groupe d'Analyse et de Théorie Economique Lyon - Saint-Etienne - ENS de Lyon - École normale supérieure de Lyon - UL2 - Université Lumière - Lyon 2 - UJM - Université Jean Monnet - Saint-Étienne - CNRS - Centre National de la Recherche Scientifique, Centre Léon Bérard [Lyon])

Abstract

Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

Suggested Citation

  • Marius Huguet & Xavier Joutard & Isabelle Ray-Coquard & Lionel Perrier, 2022. "What underlies the observed hospital volume- outcome relationship?," Post-Print halshs-01801598, HAL.
    • Handle: RePEc:hal:journl:halshs-01801598
    DOI: 10.1186/s12913-021-07449-2
    Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-01801598
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    3. Marius Huguet & Lionel Perrier & Olivia Bally & David Benayoun & Pierre de Saint Hilaire & Dominique Beal Ardisson & Magali Morelle & Nathalie Havet & Xavier Joutard & Pierre Méeus & Philippe Gabelle , 2018. "Being Treated In Higher Volume Hospitals Leads To Longer Progression-Free Survival For Epithelial Ovarian Carcinoma Patients in the Rhone-Alpes region of France," Post-Print halshs-01670155, HAL.
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    More about this item

    Keywords

    Volume outcome relationship; France; Epithelial Ovarian Cancer; Instrumental variable; Organization of care; Care pathway; Learning effect; Centralization of care;
    All these keywords.

    JEL classification:

    • C31 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models; Quantile Regressions; Social Interaction Models
    • C36 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Instrumental Variables (IV) Estimation
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L11 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Production, Pricing, and Market Structure; Size Distribution of Firms

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