English health policy has moved towards establishing specialist multi-disciplinary teams to care for patients suffering rare or particularly complex conditions. But the healthcare resource groups (HRGs), which form the basis of the prospective payment system for hospitals, do not explicitly...

If specialisation is supposed to reduce costs why is reimbursement often more generous for specialist than non-specialist hospitals? Specialist hospitals claim that gains from specialism are offset because they attract patients with more complex care requirements. We assess the foundation for...

Accounting for variation in the quality of care is a major challenge for the assessment of hospital cost performance. Because data on patients’ health improvement are generally not available, existing studies have resorted to inherently incomplete outcome measures such as mortality or...