Hospitals have grown too big

Over the last decade, hospitals in the Netherlands have become an impressive 19 percent more productive. Of this gain, 5 percent was lost due to inefficiencies of scale.

Economists from the faculty of Technology, Policy & Management presented their findings on the productivity and efficiency in Dutch hospitals between 2003 and 2009 at a congress held at the Ministry of Health last Thursday. The researchers from the centre for innovations and public sector efficiency studies (Ipse studies) essentially told the audience that Dutch hospitals had grown beyond their optimal growth levels: increasing production capacity by 1 percent boosts the costs by 1.23 percent. “Growth of scale thus hinders the development of productivity,” the report states. And yet, although the wave of hospital fusions may have dissipated, fusions do still occur.

So how did the Ministry of Health react to the report’s findings? There hasn’t been an official reaction, yet, but according to econometrician, Bart van Hulst (MSc), the ministry employees who were present were not convinced that mega-hospitals work less efficiently. No ban on fusions so far.

The researchers gathered data from around 90 Dutch hospitals over a seven-year period, which amounted to 500 observations, and from this data they calculated the cost function: how the cost of a hospital depends on the product (in this case: treating the patient) and the input prices, such as hospital staff, facility costs and materials used.

Their analysis shows a formidable increase (+35 percent) in the productivity of the nursing staff. In other words: one-third more patients were treated. The explanation for this is the shorter duration of hospital stays, thanks to new treatment methods and insights.

The researchers do note however that there is an increased use of medication and that a patient leaving hospital often needs additional care to recover, be it at home or in a nursing home, both of which are less expensive than a hospital bed.

Researcher Dr Jos Blank suggests that large hospitals may improve their productivity by focussing on a limited number of specialisations. A future Ipse study on innovations and productivity increase may shed light on this issue. 

The new chopper reminded the New Scientist of the fictional flying machines in the spectacular TV series, Airwolf and Blue Thunder. The magazine argued that it’s big news that helicopters with extra rotors are currently being developed. In the coming years these new machines will be able to break the speed record for choppers of 400 km/h, which was set in the 1980s by a modified Westland Lynx. The two new helicopters are being developed by Sikorsky and Eurocopter.

“It’s a fascinating development, but the design of the fast choppers is not very new,” says assistant professor of helicopter flight dynamics, Dr Marilena Pavel (Aerospace Engineering). “The Sikorsky X2 is a compound helicopter and has coaxial rotors (two on top of each other) and a pusher propeller at the back. The legendary Sikorsky XH-59A Advanced Blade Concept was based on the same concept.” This chopper flew 518 km/h using two extra pulsejets. “The X2 is the follow-up of that helicopter.”

The XH-59A has had problems in the past. “It wasn’t stabile enough at a low speed, and at high speeds the helicopter’s vibrations made it hard to control. By using new techniques, like active stabilization and better airfoils, those problems should belong to the past. I think both helicopters have a fair chance to break the speed record.”

The Eurocopter X3 has a different design than the Sikorsky. It has one big main rotor on top and two side propellers. “For both helicopters, the big rotor causes the lift. It also takes care of some of the forward speed. But if one would like to go very fast, rotors on top cause a lot of noise; therefore, the propellers are attached to the X2 and X3 for extra acceleration. Because there are so many rotors and even small wings, they almost look more like airplanes than helicopters,” says helicopter specialist, Joris Melkert (Aerospace Engineering).

He argues that the extra rotors do not make the X2 and X3 very efficient. “For vertical take-off and landing only the big rotor is needed – the small propellers are useless. If one accelerates, the big rotor becomes more and more redundant with increasing forward speed. There are a lot of heavy rotors on board that only have one specific option, and aviation is all about weight. I do not think these helicopters have a bright future ahead of them.”
Dr Pavel does not agree: “Airports are very crowded and busy. These helicopters could be used to transfer travellers from one place to another. And they have the big advantage that they do not need a runway to land. I think that will make them attractive to fly where jets cannot, such as at smaller airports.”

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