this may notably reflect supplierinduced volume growth in the segment b as suggested by the differences between treatments provided by salaried and selfemployed specialists upcoding classifying patients into higher priced diagnostic codes and excessive billing in about five per cent of cases hasaart douven et al since hospital productivity has increased by partly thanks to a improvement in labour productivity of nursing personnel blank et al further scope for efficiency improvements comes from the fact that general hospitals are often operating on an inefficiently large scale reflecting a lack of specialisation and a tight network of large hospitals that ensures most people have access to an emergency unit within less than minutes blank et al