Efficiency evaluation for pooling resources in health care

Hospitals traditionally segregate resources into centralized functional departments such as diagnostic departments, ambulatory care centers, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficiency in service delivery can be achieved when services are organized around patient groups. Examples include specialized clinics for breast cancer patients and clinical pathways for diabetes patients. Hospitals are struggling with the question of whether to become more centralized to achieve economies of scale or more decentralized to achieve economies of focus. In this paper we examine service and patient group characteristics to study the conditions where a centralized model is more efficient, and conversely, where a decentralized model is more efficient. This relationship is examined analytically with a queuing model to determine the most influential factors and then with simulation to fine-tune the results. The tradeoffs between economies of scale and economies of focus measured by these models are used to derive general management guidelines.