Abstract
BackgroundThe number of independent treatment centres (ITCs) has grown substantially. However, little is known as to whether the volume-quality relationship exists within this sector and whether other possible organisational factors mediate this relationship. The aim of this study is to gain a better understanding of such possible relationships.MethodsData originate from the Dutch Health and Youth Care Inspectorate (IGJ) and the Dutch Patients Association. We used longitudinal data from 4 years (2014–2017) including three different quality measures: 1) composite of structural and process indicators, 2) postoperative infections, and 3) patient satisfaction. We measured volume by the number of invasive treatments. We adjusted for three important organisational characteristics: (1) size of workforce, (2) chain membership, and (3) ownership status. For statistical inference, random effects analysis was used. We also ran several robustness checks for the volume-quality relationship, including a fractional logit model.ResultsITCs with higher volumes scored better on structure, process and outcome (i.e. postoperative infections) indicators compared to the low-volume ITCs – although only marginally on outcome. However, ITCs with higher volumes do not have higher patient satisfaction. There is a decreasing marginal effect of volume – in other words, an L-shaped curve. The effect of the intermediating structural factors on the volume-quality relationship (i.e. workforce size, chain membership and ownership status) is less clear. Our findings suggest that chain membership has a negative influence on patient satisfaction. Furthermore, for-profit providers scored better on the Net Promoter Score.ConclusionsOur study shows with some certainty that the quality of care in low-volume ITCs is lower than in high-volume ITCs as measured by structural, process and outcome (i.e. postoperative infection) indicators. However, the size of the effect of volume on postoperative infections is small, and at higher volumes the marginal benefits (in terms of lower postoperative infections) decrease. In addition, volume is not related to patient satisfaction. Furthermore, the association between the structural intermediating factors and quality are tenuous.
Highlights
The number of independent treatment centres (ITCs) has grown substantially
The growth in ITC market share has been made possible by advances in technology, which have enabled more invasive treatments to be relocated from inpatient hospital care to ambulatory care settings [4]
Descriptive statistics ITC characteristics The number of invasive treatments shows substantial variation between ITCs with, on average, 1572 invasive treatments per ITC but a high standard deviation of
Summary
The number of independent treatment centres (ITCs) has grown substantially. Independent treatment centres (ITCs) are enjoying a growing market share in low-risk invasive ambulatory treatments such as cataract surgery and carpal tunnel syndrome [1,2,3]. The growth in ITC market share has been made possible by advances in technology, which have enabled more invasive treatments to be relocated from inpatient hospital care to ambulatory care settings [4]. In the United States (US), between 2000 and 2010, the number of Medicare-certified independent ambulatory surgery centres (referred to as ASCs in the US) increased on average by 5.4% per year [1]. The Netherlands experienced a growth in the number of ITCs (in terms of the number of locations at which care is provided, or ‘ITC locations’), of 87% between 2009 and 2016 [5]. ITCs still have a small share of 3.8% of total reimbursable care in the Netherlands in 2016, for some procedures their share is considerably higher; for example, ITCs provide 18.4% of the total ophthalmological procedures and 18.2% of the dermatological treatments [6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
