Concentration of cancer surgery in fewer clinics improves the quality of care

Daniel Avdic, Research Fellow, Centre for Health Economics, Monash Business School, Australien

In a new SNS report, Daniel Avdic, researcher in Health Economics, found positive effects of concentrating cancer surgery to fewer hospitals. It leads to higher survival rates, less post-surgery complications and less need for follow-up surgeries. According to the study, this is mainly explained by the increase in surgery volume so that the individual surgeons can learn from practical experiences.

sns-research-brief-no-62-the-volume-outcome-relationship-in-healthcare-english-summary.pdf 86.2 KB PDF

Work is currently underway on concentrating highly specialized care in Sweden, it implies consolidating the care for certain diagnoses to fewer hospitals or clinics. This work was initiated following an official report of the Swedish government called “Practice makes perfect: Concentrated care for the patient’s best interests” published in 2015. This report has caused much debate and has received quite a lot of criticism. The highly specialized care focuses on diagnoses where the patient groups are quite small, which can make it difficult to study the effects of concentration of the care. It is therefore important to compare these groups with other types of care. The study that Avdic conducted together with Petter Lundborg and Johan Vikström gives clear support for concentrating cancer surgery.

There are already quite a few studies showing positive associations between patient volume and care quality. However, there are few studies showing that increased volumes actually lead to improved quality. The researchers used register data and paired it with data on closures of clinics providing cancer surgery in the 1990s and early 2000s. The closures resulted in large increases in patient volume in the remaining cancer clinics.

The results show considerable positive effects of more patients being treated at the same hospital. Patient survival rates increased, the risk for complications decreased and life quality after surgery improved. Yet, the costs, approximated by time spent in care, did not increase substantially.

– Our simulations show that a national concentration of cancer surgery could save around 100 lives a year, says Daniel Avdic, Research Fellow at the Center for Health Economics at Monash University.

According to Avdic, the most important factor in the observed effect is that the surgeons get more opportunities for practice. In order to take advantage of the positive effects of care concentration, it is important that potential reforms focus on individual surgeons or doctors. But the concentration of care is also associated with challenges.

– We must not forget that an excessive concentration can create an untenable workload for the staff at the remaining clinics. Then we risk that the positive effects of concentration decline, since other groups of patients become worse off, says Avdic.

Avdic also points out that it is important to remember that the report focuses on cancer surgery. The results cannot be automatically be applied to other activities within the health care sector.

The report is part of the SNS research project Health care in the 21st century.