London Health Economics Study Group

5-6pm: Nicos Savva

Title: Economies of scale and scope in hospitals

Abstract: General hospitals across the world are becoming larger (i.e. admitting larger volumes of patients each year) and more complex (i.e. o ffering more complex portfolios of services to patients with diverse levels of acuity). Although prior work has shown that increased volume is positively associated with patient outcomes, it is less clear how volume interacts with organizational complexity to a ffect costs across service lines and acuity levels. This paper investigates this relationship using panel data for 14 service lines comprising both elective and emergency admissions across 130 hospitals in England over a period of nine years. Although we find signi ficant economies of scale for both elective and emergency admissions, we also find evidence of negative economies of scope across the two admission types, with increased elective volume at a hospital being associated with an increase in the cost of emergency care. Furthermore, for emergency admissions we nd evidence of economies of scope across service lines - increased emergency activity in one service line is associated with lower costs of emergency care in other service lines. By contrast, we find no evidence of such economies of scope across service lines for elective admissions. Our findings have implications for individual hospitals and for the organization of regional hospital systems. Speci cally, at the hospital level our fi ndings suggest that growth strategies that target elective patients may have unintended negative productivity implications for emergency services. At the regional level, our findings o ffer support for the reorganization of regional hospital systems toward general hospitals that focus on the provision of emergency care across a full range of services, complemented by high-volume clinics that focus on elective services in a single service line.


6-7pm: Alice Mesnard


Title: Do men and women have equal access to health care? Evidence on health care utilization in Nigeria

Abstract: This paper explores the effect of price, distance and quality in explaining the choice of health providers in Nigeria. We use a rich dataset from the state of Kwara which includes information on the entire portfolio of health facility available to the households living in rural areas and examine the determinants of health seeking behaviour by estimating alternative discrete choice models. In contrast to most of the literature, we correct for the endogeneity of price using a control function approach and show that our results are sensitive to the instrumentation of price. The findings show that price, distance and quality are strong determinants of health provider choice. We find that women's demand for formal health care is more responsive to price changes, with suggestive evidence that these differences are due to intra-household bargaining power relations.