Factors associated with hospital closure and merger: a survival analysis of Dutch hospitals from 1978 to 2010.

Health policy in most West European countries is directed at transforming the healthcare systems into more self-regulating and competitive systems. After a period of strong regulation, the Dutch government decided to step back and created conditions in which competition could lead to cost management and quality improvement. The question is whether mergers have contributed to the survival chances of hospitals. This paper describes the results of an analysis performed on the survival of all Dutch hospitals in the years 1978 to 2010. The survival of hospitals during this period was determined and their survival rates were calculated statistically. Furthermore, the relation between a hospital's lifespan and a number of predictive variables was investigated. In this study, more detailed consideration is given to the fact of whether a hospital merged with another hospital. Bivariate analysis shows that smaller hospitals in particular have been driven out of the market. The difference in lifespan between hospitals which had merged and those which had not, appeared to be significant. However, a multivariate analysis, when corrected for size, type, and location, showed that merging had no significant effect on hospital lifespan.