Page 149 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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Do private hospitals outperform public hospitals regarding efficiency, accessibility and quality of care in the European Union? A literature review
providers, while prospective structures as in acute care seem to create an opposing effect. Both underline the idea the private providers respond more intensely to incentives than public hospitals. This is tested in a more head to head approach by Schwierz (2011). The author identifies that the introduction of a new payment system in 2014 pushed for economic discipline and penalized high-cost hospitals, creating incentives for German private hospitals to take over public hospitals (Schwierz, 2011). In general, FP hospitals were also found to respond faster to increasing demand than other ownership types. Public hospitals were more likely to default; therefore privatization became an appealing option (Schwierz, 2011). Another study, also conducted in Germany, analyzes changes in hospital staff after privatization. This study discovers that FP privatization reduced staff per inpatient case (especially nurses, other non-physician clinical staff and other non-clinical staff). Such findings were not found when NFP hospitals were the acquiring party (Heimeshoff et al., 2014). Similar finding were found in Greece, FP hospitals seem to have lower nursing staff rates for nurses compared to the public hospitals (Kondilis et al., 2011).
 Finally two studies addressed upcoding. In Italy, Vittadini et al. (2012) looked at registering patients with non-existing complications to increase reimbursement. There was evidence that both NFP and FP hospitals were to some extent engaged in ‘upcoding’ before a specific law against ‘upcoding’ in 2007 was institutionalized. No such evidence was found for public hospitals (Vittadini et al., 2012). Berta et al. (2010) also found that during 2003- 2005, FP hospitals had more intense ‘upcoding’ practices than other hospital types (Berta et al., 2010). However, no ownership differences were found after 2005, probably due to more severe checks implemented after 2003 (Berta et al., 2010).
Number         Type (private) Countries     Impact
Table 7.4: Other efficiency measures
    Outcome/ indicator
              Length of stay
      knee procedures in private hospitals
Kingdom,
have shorter LOS
   mental health clinics) hospitals and
France
 have longer LOS
          Responsiveness to demand
             Employment
                          Upcoding
       have more
              of studies
3         Aortic valve substitution, hip and Italy,United       Privatehospitals
or ISTCs France
3         Private (i.e. psychiatric hospitals,   Italy, Greece,         Private hospitals
specifically for knee procedures
1         ISTCs (for most diagnostic groups)     United
No difference
Kingdom 1         FP Germany
Private hospitals are more responsive
No difference Private hospitals have lower staff rate Private hospitals
1 NFP     Germany 2                 FP Germany,
Greece 1         NFP + FP   Italy
‘upcoding’ No difference
1                 NFP + FP     Italy
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