Politicians may not have same goals as clinicians with regard to mergers

BMJ 1999;318:1762 ( 26 June )

Letters

Politicians may not have same goals as clinicians with regard to mergers

The first 150 words of the full text of this article appear below.

EDITOR $---$ Garside's editorial on evidence based mergers confuses outcomes and process.¹ She wants to collect evidence on "howto manage the process of merging" as well as to assemble "evidenceon the benefits of NHS mergedorganisations."

International evidence on the benefits of mergers and the influence of hospital size on the quality of, cost of, and accessto care has been extensively reviewed by the NHS Centre for Reviewsand Dissemination ² ³ and published in a book.⁴ This indicatesthat (a) unit costs fall little beyond 600 beds; (b) quality (interms of mortality) can sometimes, but may not always, be improvedby increased volume; and (c) concentrating services increasestravel costs for patients and carers, affecting access and usedifferentially in terms of social class. In the United Statesmerger mania is largely the product of "an oligarchy of executiveswho are reacting . . . [Full text of this article]