Page 153 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Do private hospitals outperform public hospitals regarding efficiency, accessibility and quality of care in the European Union? A literature review
efficiently than public facilities. In Italy, private psychiatric clinics collaborated less intensely with the community system as public psychiatric departments do (Preti et al., 2009).
From discharge data extracted from Emilia-Romagna hospitals, the appropriateness of admission was evaluated. Although the number of inappropriate admissions decreased between 2001 and 2005, private hospitals exhibit in all years more inappropriate admissions than public hospitals (Louis et al., 2008). Private hospitals are also showing less adherence to antenatal screening among pregnant women in six Italian regions (Stroffolini et al., 2003). A study on Austrian hospitals shows that adherence to the guidelines for colorectal cancer screening was worse among private hospitals. After the implementation of a guideline for colorectal screening only 3.8% of private hospitals changed their routine practice versus 14.2% of public hospitals (Britto-Arias et al., 2015).
Process
In Germany, Tiemann & Schreyögg (2009) analysed hospital mortality rates. They found that, controlling for case-mix differences, FP and NFP hospitals showed better mortality figures than the public sector. One of the potential explanations for this finding might be that publicly enforced transparency on quality indicators, seems to have stimulated FP hospitals to put comparatively more emphasis on such issues (Tiemann and Schreyögg,
Outcomes
2009). France was the country were the two included studies on quality outcomes indicated a consistently worse performance for the private sector. Mortality rates for patients aged over 35 and admitted for heart attacks were found to differ among hospital types. Public (non-teaching) hospitals have a lower mortality rates compared to FP hospitals (Gobillon and Milcent, 2016). Rehospitalisation rates, a possible indicator for worse quality, differ as well between French hospitals. Private hospitals have higher rates of 30-day all-cause rehospitalisations of older patients compared to public providers (Gusmano et al., 2014).
In Italy, regional degrees of privatization (1993-2003) are used as a quasi natural experimental design to investigate the association between public and private hospital spending on (the reduction of) avoidable mortality. Spending increases on public delivery of health care services was associated with increased reduction in avoidable mortality. However, no such positive effects were found with respect to spending increases on private health care services. This implies that increases of spending on private health care services might hamper the possible reduction in avoidable mortality by investments in the public
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