The impact of learning on cost: the case of heart transplantation

The effect of increased experience on outcomes is evaluated for a heart transplantation program. While previous research on surgical procedures has documented a strong and consistent relationship between experience and quality (mortality and complication rates), little correlation has been found between experience and cost. Most of this research has relied on comparisons between different-sized programs at the same point in time, making it difficult to interpret. The lack of clear financial incentives in the past may also have muted a relationship between cost and experience that has been consistently documented and used in planning the production of almost all other non-health-related goods and services. The traditional operations research or managerial accounting model for projecting the impact of learning on four measures of cumulative average resource consumption (death rates, length of stay, billing units, and charges), modified to include a lower limit, was applied to the experience of a heart transplant program. The data fit the model well. The slope of the learning curve is steepest for death rates and flattest for charges. Possible implications of such learning curves on the strategic thinking of institutions and the planning and management of health services are discussed.