Economies of scale and optimal size of maternity services in Belgium: A Data Envelopment Analysis.

This article uses a Data Envelopment Analysis to measure scale efficiency of maternity services in Belgium and estimate the minimum efficient scale in this context. Using administrative data for all maternity services in Belgium in 2016, the minimum efficient scale is estimated at 557 deliveries per year, which is above the currently prevailing norm of 400 deliveries per year. In particular, the closure of 17 small maternity services could improve efficiency without reducing accessibility. In addition to that, further efficiency gains could be attained by increasing the scale of maternity services up to at least 900 deliveries per year. Although most services are close to scale efficiency, the mean scale inefficiency level is 13% and low scores are mainly concentrated among the smallest services. These results are robust to changes in model specifications, bootstrapping and removal of outliers. In the current context of reform of the hospital and maternity landscape in Belgium, this study shows room for improvement and the possibility to generate substantial efficiency gains that could be reinvested in the healthcare system.