Page 141 - 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
Chapter 7
Do private hospitals outperform public hospitals regarding efficiency, accessibility and quality of care in the European Union? A literature review
It is an ongoing debate what the role of the private sector in the health care system should be. In theory, under competitive forces and the right preconditions, private hospitals might outperform public providers. However, empirical evidence, mostly originating from the United States (US), does not confirm such hypothesis (Hollingsworth, 2003; Schlesinger and Gray, 2006; Sibbel and Nagarajah, 2012). For example, Schlesinger & Gray (2006) find that although the evidence is mixed, it seems to favour non-profit hospitals (Schlesinger and Gray, 2006). Eggleston et al. (2008) analysing differences in quality of care also finds mixed evidence (Eggleston et al., 2008). Herrera et al. (2014) provide an overview of systematic reviews focusing on quality of for-profit (FP), not-for-profit (NFP) and public providers. Among other things, they concluded that FP providers have higher mortality rates (Herrera et al., 2014). US studies illustrate that NFP hospitals seem to mimic FP hospitals on more competitive markets, which might blur the distinctions between both ownership types (Horwitz and Nichols, 2009).
7.1 Introduction
Most European health markets are both less competitive and more inclusive than the US, which may provide private providers with different incentives. During the past decades, a high amount of public provision spurred discussions about possible inefficiencies and a movement towards privatization could be observed across Europe (Jeurissen et al., 2016; Maarse, 2006). Nowadays, practically all EU health systems ’contract’ both public and private providers. However, EU countries do differ regarding the scale and scope of private hospitals. In most Bismarck type systems, private hospitals may be on par with public hospitals: public and private providers provide comparable services and are reimbursed in a similar way. To illustrate, in Germany, the private sector, both the FP and NFP sector, run comparatively similar hospitals (i.e. size, type of treatments offered) as public hospitals (Busse and Blümel, 2014). Other countries contain more contextual differences between private and public provision. In France, public hospitals mainly provide acute medical care, whereas FP hospitals seem to specialize in profitable procedures and outpatient care (Chevreul et al., 2015). In Austria, public hospitals are the dominant players, but the non- profit sector also provides a part of the hospitals services (Hofmarcher and Quentin, 2013).
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