Page 139 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

7 Do private hospitals outperform public hospitals regarding efficiency, accessibility and quality of care in the European Union? A literature review
Kruse, F. *, Stadhouders, N. *, Adang, E., Groenewoud, S., & Jeurissen, P.
*Shared first authorship
Published in The International journal of health planning and management. (2018);33(2):e434-e453.
European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality and efficiency in healthcare. This raises questions about the relative performance of private hospitals compared to public hospitals. Most systematic reviews that scrutinizes the performance of the private hospitals originates from the United States (US). A systematic overview for Europe is non-existing. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, UK, France, Greece, Austria, Spain and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: patients with higher social-economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for-profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures, or be hesitant to accommodate the growth of the private hospital sector.
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Abstract