Abstract：
OBJECTIVE: Current policy responses to COVID-19 disruption and care backlogs suggest potential changes to the location and structure of hospital healthcare supply. However, few studies investigating the cost effects of hospital reorganisation consider changes in the mix of outputs or test for the existence of economies of scope in hospital healthcare. Attempts to create dedicated hubs to address healthcare demand backlogs could have unintended adverse cost effects where these are provided outside existing hospital arrangements. To evaluate this, we investigate the existence and size of economies of scope in English hospital healthcare.
METHODS: We use cost and activity data from the English NHS, linked to aggregated staff wage information and information taken from hospital financial statements. Cost and activity data was obtained from NHS England\'s Costing Publications. Wage data was extracted from the NHS\'s Electronic Staff Record via the NHS England Workforce Statistics Team, and published hospital financial accounts were aggregated and linked together at the organisation level.
RESULTS: General Surgery exhibited positive economies of scope when provided alongside other healthcare, as to a lesser extent did General Medicine and Obstetric/Gynaecology healthcare. There was little evidence for economies of scope in Diagnostic and Pathology services, Orthopaedics, or Emergency Care. Few (2/28) output cross-products (cost complementarities) were statistically significant, but Baumol\'s wider definition of scope economies demonstrates that scope economies are present in some specialties.
CONCLUSIONS: Policymakers seeking to maximise the amount of healthcare provided and minimise the costs of doing so may wish to consider retaining General Surgery, General Medicine and Obstetric/Gynaecology healthcare supply alongside the provision of other clinical specialties. There is limited evidence that reconfiguring supply by centralizing other specialty groups into fewer providers would increase costs.
METHODS: We use cost and activity data from the English NHS, linked to aggregated staff wage information and information taken from hospital financial statements. Cost and activity data was obtained from NHS England\'s Costing Publications. Wage data was extracted from the NHS\'s Electronic Staff Record via the NHS England Workforce Statistics Team, and published hospital financial accounts were aggregated and linked together at the organisation level.
RESULTS: General Surgery exhibited positive economies of scope when provided alongside other healthcare, as to a lesser extent did General Medicine and Obstetric/Gynaecology healthcare. There was little evidence for economies of scope in Diagnostic and Pathology services, Orthopaedics, or Emergency Care. Few (2/28) output cross-products (cost complementarities) were statistically significant, but Baumol\'s wider definition of scope economies demonstrates that scope economies are present in some specialties.
CONCLUSIONS: Policymakers seeking to maximise the amount of healthcare provided and minimise the costs of doing so may wish to consider retaining General Surgery, General Medicine and Obstetric/Gynaecology healthcare supply alongside the provision of other clinical specialties. There is limited evidence that reconfiguring supply by centralizing other specialty groups into fewer providers would increase costs.
摘要：
目标：目前对COVID-19中断和护理积压的政策反应表明，医院医疗保健供应的位置和结构可能发生变化。然而,很少有调查医院重组的成本效应的研究考虑到产出组合的变化，或者测试医院医疗保健中范围经济的存在。试图创建专门的中心来解决医疗保健需求积压可能会产生意想不到的不利成本影响，这些影响是在现有医院安排之外提供的。为了评估这一点，我们调查了英国医院医疗保健中范围经济的存在和规模。
方法：我们使用来自英国NHS的成本和活动数据，链接到汇总的员工工资信息和取自医院财务报表的信息。成本和活动数据来自NHS英格兰的成本计算出版物。工资数据是通过NHS英格兰劳动力统计小组从NHS的电子员工记录中提取的，和公布的医院财务账目在组织一级汇总和联系在一起。
结果：普外科与其他医疗保健一起提供时表现出积极的范围经济，普通医学和产科/妇科医疗保健在较小程度上也是如此。几乎没有证据表明诊断和病理服务的范围经济，骨科,或紧急护理。很少(2/28)产出交叉产品(成本互补性)具有统计学意义，但鲍莫尔对范围经济的更广泛定义表明，范围经济存在于某些专业中。
结论：政策制定者寻求最大限度地提高提供的医疗保健的数量，并尽量减少这样做的成本，不妨考虑保留普外科手术。普通医学和产科/妇科医疗保健供应以及其他临床专科的供应。有限的证据表明，通过将其他专业小组集中到较少的提供商中来重新配置供应会增加成本。
方法：我们使用来自英国NHS的成本和活动数据，链接到汇总的员工工资信息和取自医院财务报表的信息。成本和活动数据来自NHS英格兰的成本计算出版物。工资数据是通过NHS英格兰劳动力统计小组从NHS的电子员工记录中提取的，和公布的医院财务账目在组织一级汇总和联系在一起。
结果：普外科与其他医疗保健一起提供时表现出积极的范围经济，普通医学和产科/妇科医疗保健在较小程度上也是如此。几乎没有证据表明诊断和病理服务的范围经济，骨科,或紧急护理。很少(2/28)产出交叉产品(成本互补性)具有统计学意义，但鲍莫尔对范围经济的更广泛定义表明，范围经济存在于某些专业中。
结论：政策制定者寻求最大限度地提高提供的医疗保健的数量，并尽量减少这样做的成本，不妨考虑保留普外科手术。普通医学和产科/妇科医疗保健供应以及其他临床专科的供应。有限的证据表明，通过将其他专业小组集中到较少的提供商中来重新配置供应会增加成本。
