The model treats hospitals as exchangeable and assumes the same exponential mixing law for their total expected annual counts. Its shape is fixed: the prior standard deviation equals its mean. Real hospitals differ in size, patient mix, ascertainment and observation effort, so expected counts should not generally share one distribution without accounting for these predictors. Common regional conditions can also invalidate their assumed conditional independence. The resulting geometric distribution for observed counts is a restrictive distributional prediction that can be checked.
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