Volume of clinical activity in hospitals and healthcare outcomes, costs, and patient access.

Concentration of the provision of hospital services is sometimes seen as a way to reduce costs and improve the quality and efficiency of care. This paper, based on an issue of Effective Health Care Vol 2, No 8 summarises the results of systematic reviews carried out at the Univer- sity of York to assess research into the possible relation between volume of clinical activity in hospitals and the outcomes of quality of health care, hospital costs (economies of scale), and patient access. Full reports of the methods used and the results of these reviews, including details of the studies included, are avail- able from the National Health Service (NHS) Centre for Reviews and Dissemination and cannot be presented here due to lack of space.