Samenvatting

Social welfare has often been presented in the hospital research area in terms of travel costs and or distances. Most hospital cost studies only focus on the private costs generated by hospitals caring for patients. However, patient inputs in terms of patient travel cost and time cost are often neglected. In this article we combine both these factors, and optimize the social cost being the sum of the operating cost of hospitals and the costs of accessibility. This article presents a pure economic model for optimizing the social costs, the optimum gives us insight in the lowest hierarchical administrative level on which the provision of hospital care can be planned.

The model is applied to the Flemish hospital sector for three types of products: revalidation, basic hospital care and radiotherapy. In this study, we point out that as the population (and patient base) increases, existing hospitals would have to expand moving further along the average cost curve into the region where decreasing returns to scale would prevail and by definition, higher cost. Building another hospital could both relieve the pressure on existing hospitals as well as decrease aggregate patient travel costs, i.e., social costs. By dividing the district into regions, we are able to establish the optimal number (and size) of hospitals. We found that the Flemish region should not be divided too much even though travel costs are minimized since the hospitals would be too large and too costly.