Scaling Laws in Healthcare Delivery. A Network Analysis Approach to Outpatient Referral Networks Across the Veterans Health Administration

BACKGROUND We studied clinical referral networks across the Veterans Health Administration. Network attributes, referral counts and timeliness of services rendered were estimated and used to predict outpatient care performance. A scaling law for outpatient referrals was derived, predicting an economy of scale. METHODS Network topology and operational statistics were estimated and their relationships were studied. A comparative study of multiple networks was undertaken. RESULTS We observed similarities both in network structure and in the referral patterns. These are invariant of the healthcare system size. A power scaling law for referrals was inferred with an infra-linear exponent. CONCLUSION Study of referral networks across multiple healthcare systems shows an economy of scale and self-similarity between network attributes that are patient size invariant.