This may notably reflect supplier-induced volume growth in the segment B - as suggested by the differences between treatments provided by salaried and self-employed specialists - up-coding (classifying patients into higher priced diagnostic codes), and excessive billing (in about five per cent of cases) (Hasaart, 2011; Douven et al., Since 2003, hospital productivity has increased by 15%, partly thanks to a 35% 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 15 minutes (Blank et al.,