There is both an upper and a lower efficiency boundary for concentrated service configurations.
At the upper end, the large 1000 to 2000 bed hospitals and huge public health
laboratories in central and eastern Europe were characterized by over-specialization, low
productivity and low quality of care (44). At the lower end, there are also considerable
efficiency and quality problems when facilities that perform specialized care are too small.
Cottage or district-level hospitals with 20 to 50 beds are common in many low and middle
income countries, such as Ethiopia, Morocco, and Turkey, especially in rural regions and in
the private sector (45). Often they have low bed-occupancy rates and the staff do not see a
sufficient volume of patients to maintain the clinical skills needed to treat rarer conditions.
They may deal well with more common conditions, but then they must be integrated into
a referral system that can treat more difficult or unusual ailments.
There is both an upper and a lower efficiency boundary for concentrated service configurations.At the upper end, the large 1000 to 2000 bed hospitals and huge public healthlaboratories in central and eastern Europe were characterized by over-specialization, lowproductivity and low quality of care (44). At the lower end, there are also considerableefficiency and quality problems when facilities that perform specialized care are too small.Cottage or district-level hospitals with 20 to 50 beds are common in many low and middleincome countries, such as Ethiopia, Morocco, and Turkey, especially in rural regions and inthe private sector (45). Often they have low bed-occupancy rates and the staff do not see asufficient volume of patients to maintain the clinical skills needed to treat rarer conditions.They may deal well with more common conditions, but then they must be integrated intoa referral system that can treat more difficult or unusual ailments.
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