Is bigger better? Findings from a review on health outcomes and processes after merging of hospitals

Background Many hospital mergers have taken place in different health systems of different countries in the last two decades. Despite governments and private healthcare sector continue pursuing these activities, little attention is paid to the assessment of their impact. The aim of this study is to comprehensively review literature on findings of hospital mergers in terms of clinical outcomes and processes. Methods A comprehensive review of the literature was carried out by querying general and scientific electronic databases. A search string was constructed using keywords. Articles, written in English, that evaluated outcomes and processes after hospital mergers were included. Results From a total of 113, 7 studies met the inclusion criteria and were included in the review. After hospital merging, 66.7% of cardiovascular mortality indicators didn’t demonstrate any significant reduction. A significant increase of readmission rate after major cardiovascular event was shown in all of the indicators. Of the obstetrics care indicators, 83.3% revealed a significant worsening. Staff perception was evaluated in 4 articles. All of them highlighted loss of management control. Most of these studies (50-75%) refer that career prospects and job dissatisfaction are feared by personnel; on the other hand, positive perception seems to be reported in good practice sharing. Conclusions Hospital mergers could determine consequences that need to be taken into account when these processes are planned. This review suggests that merger by itself doesn’t lead to expected benefits in terms of outcomes and processes. More than structural change, functional integration in health care services should be emphasized. Furthermore, these activities should be accompanied by a coherent and consistent assessment. Key messages: Evidence do not show any automatic improvement for outcomes and processes after hospital mergers. A systematic and periodic assessment is needed in case of merging.