Page 155 - 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
private hospitals as a result of such specializations, but in France the findings predominantly seem to favour public hospitals. This casts doubt on the advantages of private hospital specialization.
This realist review analyses a complex and context dependent issue and thus is subject to various limitations. Included studies used a wide range of indicators; research designs vary substantially. This makes it somewhat problematic to extrapolate or generalize these findings. Many findings relate to specific diseases and/or indicators implying they do not necessarily hold for a broader spectrum of diseases. Studies covering efficiency showed more consistency among their use of parameters and methodology. We also were able to only include studies from a limited number of EU countries. The majority of the evidence compromises a few countries: Italy, Germany, France, the UK, and Greece. However, these five countries do cover for a substantial part of the total EU population and – more importantly – cover for most healthcare system types (tax-funded or social insurance, multiple payer and single payer, decentralized and more centralized). Including articles not written in English could broaden the scope of this research. Furthermore, transferability of our results from one country to another is a difficult and complex task (Goeree et al., 2007). The performance of different types of hospital ownership may be highly dependent on their embeddedness in health system ecosystems. Schlesinger and Gray (2006) mention a valid criticism when stating that “much apparent inconsistencies in the effect of ownership emerge when scholars carelessly combine findings based on different health services or performance measures”(p. 289)(Schlesinger and Gray, 2006). Indeed, private hospitals may compete, specialize or complement public providers, which could partly explain conflicting outcomes. A more thorough understanding of the position of the private sector in the wider health system could aid policy makers in designing sound and evidence-based policies in this area.
We reviewed forty-five studies on the performance of the private hospital sector in EU countries. To our knowledge, this to date is by far the largest review on this issue in EU countries. We sought to fill this gap in the literature. We provide policymakers with several take-away messages. Firstly, the private hospital sector consists of many complex layers. Both a polarizing political debate and traditional economist reasoning towards the superiority of a free or (loosely) regulated market also in healthcare do not suit the complexity of the issue. Secondly, our evidence shows that one should take a careful note to
7.4.1 Limitations
7.4.2 Conclusion
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