Vaughan Louella, Edwards Nigel
The Nuffield Trust, London, UK.
Future Healthc J. 2020 Feb;7(1):38-45. doi: 10.7861/fhj.2019-0066.
Smaller hospitals internationally are under threat. The narratives around the closure of smaller hospitals, regardless of size and location, are all constructed around three common problems - cost, quality and workforce. The literature is reviewed, demonstrating that there is little hard evidence to support the contention that hospital merger/closure solves these problems. The disbenefits of mergers and closures, including loss of resources, increased pressure on neighbouring organisations, shifting risk from the healthcare system to patients and their families, and the threat hospital closure represents to communities, are explored. Alternative structures, policies and funding mechanisms, based on the evidence, are urgently needed to support smaller hospitals in the UK and elsewhere.
国际上的小型医院正面临威胁。关于小型医院关闭的说法，无论规模和地点如何，都围绕着三个常见问题构建——成本、质量和劳动力。本文对相关文献进行了综述，表明几乎没有确凿证据支持医院合并/关闭能解决这些问题这一论点。探讨了合并和关闭的不利之处，包括资源损失、对周边机构压力增加、医疗系统风险向患者及其家庭转移，以及医院关闭对社区构成的威胁。迫切需要基于证据的替代结构、政策和资金机制来支持英国及其他地区的小型医院。
