MergerMania
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.
MergerMania
Neil Harris
(a don’t stop till you drop production)
Home:
helpmesortoutstpeters.blogspot.comContact: neilwithpromisestokeep@gmail.com
No comments:
Post a Comment