What Underlies the Observed Hospital Volume-Outcome Relationship?

40 Pages Posted: 14 Jun 2018

See all articles by Marius Huguet

Marius Huguet

University of Lyon 2 - Groupe d'Analyse et de Théorie Economique (GATE)

Xavier Joutard

Aix-Marseille University

Isabelle Ray-Coquard

University of Claude Bernard Lyon 1

Lionel Perrier

University of Lyon 2 - Groupe d'Analyse et de Théorie Economique (GATE)

Date Written: May 29, 2018

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.

Keywords: Volume outcome relationship, France, Epithelial Ovarian Cancer, Instrumental variable, Organization of care, Care pathway, Learning effect, Centralization of care

JEL Classification: C31, C36, I11, I18, L11

Suggested Citation

Huguet, Marius and Joutard, Xavier and Ray-Coquard, Isabelle and Perrier, Lionel, What Underlies the Observed Hospital Volume-Outcome Relationship? (May 29, 2018). Available at SSRN: https://ssrn.com/abstract=3186407 or http://dx.doi.org/10.2139/ssrn.3186407

Marius Huguet (Contact Author)

University of Lyon 2 - Groupe d'Analyse et de Théorie Economique (GATE) ( email )

93, chemin des Mouilles
Ecully, 69130
France

Xavier Joutard

Aix-Marseille University

Isabelle Ray-Coquard

University of Claude Bernard Lyon 1

43 Bl du 11 novembre 1918
Lyon, Villeurbanne cedex 69622
France

Lionel Perrier

University of Lyon 2 - Groupe d'Analyse et de Théorie Economique (GATE) ( email )

93, chemin des Mouilles
Ecully, 69130
France

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