Abstract
BackgroundDuring the last decade, pathology services in England have undergone profound changes with an extensive consolidation of laboratories. This has been driven by some national reviews forecasting a national reduction of costs by £250–£500 million ($315–$630 million) a year as a result.The main aim of this paper is to describe the financial impact of such consolidation, with a specific focus on the forecasted savings. A secondary aim is to describe the development of private sector involvement in laboratory services in a traditionally publicly funded healthcare system and the development of pathology staff size.MethodsIn the English scenario, the majority of hospitals and laboratories are publicly funded and a survey was sent as Freedom of Information request to all directors of pathology. A descriptive comparison of savings among consolidated and non-consolidated pathology services was made by using the pathology budgets in two different periods (2015 versus 2010), adjusted by inflation and increased activity.ResultsThe hub-and-spoke model has been implemented as part of the consolidation process of pathology services in England. Consolidated pathology networks have achieved higher savings compared to non-consolidated single laboratories. There has been an increased role of private providers and savings were achieved with negligible personnel redundancies.ConclusionsConsolidated units have on average achieved larger cost savings than non-consolidated units but further analysis with stronger research design is required to independently evaluate the impact of pathology consolidation on both savings and quality.
Highlights
During the last decade, pathology services in England have undergone profound changes with an extensive consolidation of laboratories
Satta and Edmonstone BMC Health Services Research (2018) 18:862 previous reports [5, 6] suggest that the cost savings achieved are typically in back-office and from the reduction of management functions rather than clinical costs, whilst savings in the pathology sector may results from the economy of scale and higher purchase discounts
These examples may represent isolated success stories as an earlier analysis of more than 700 United States (US) hospital mergers by McKinsey and the London School of Economics [7] found that the cost savings achieved were substantially less than the original anticipated benefits
Summary
Pathology services in England have undergone profound changes with an extensive consolidation of laboratories. Satta and Edmonstone BMC Health Services Research (2018) 18:862 previous reports [5, 6] suggest that the cost savings achieved are typically in back-office and from the reduction of management functions rather than clinical costs, whilst savings in the pathology sector may results from the economy of scale and higher purchase discounts. These examples may represent isolated success stories as an earlier analysis of more than 700 US hospital mergers by McKinsey and the London School of Economics [7] found that the cost savings achieved were substantially less than the original anticipated benefits. This is confirmed by a report from Norway [9] where they discovered that only one hospital out of 17 increased its cost efficiency
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