Page 142 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 7
However, in most Beveridge systems, the private sector runs parallel to the public sector as an alternative provision (Maarse, 2006). The private sector then also is paid through a parallel private funding scheme (i.e. out of pocket payments or private insurance). Greece symbolizes a hospital sector with a clear parallel private sector. The private sector in Greece includes profit-making hospitals, diagnostic centres as well as independent practices. The services are mainly privately financed through either out-of-pocket payments or private health insurance (Economou, 2010). The UK also held parallel hospitals system, but over the years an increasing number of private hospitals and independent treatments centres (ISTCs) were being commissioned by the NHS (Lafond et al., 2014). Such systematic differences may influence the composition and performance of private hospitals. Furthermore, countries differ on the extent of privatization. In some countries, such as the Nordic countries, hospital ownership is predominantly public, while in other countries, such as the Netherlands, public ownership is nonexistent.
It is currently unknown whether private hospitals outperform public hospitals in the different European health systems. Reviews on this topic are to the best of our knowledge non-existent. The main aim of this review is to compare the private sector with the public sector on efficiency, quality- and accessibility of services within the EU. We are well aware, that the profit status of private hospitals is most likely an important theoretical confounder in explaining differences in performance ever since Kenneth Arrow (1963) pointed to the fact that private non-profit status might function as a way to limit market imperfections in situations of unobservable performance of information asymmetries (Arrow, 1963). However, especially in NHS systems, distinctions between public and private provision are often at least as important as institutional demarcations, as the distinction between FP and NFP hospitals. That is the reason that we focus on the distinction between public and private. However, if indicated in the included studies, we also differentiate our results between FP and NFP private hospitals.
Our review contributes in three ways: 1) to map available literature and to highlight knowledge voids; 2) to identify differences between private and public provision; and finally 3) to find institutional and healthcare system related drivers for differences in efficiency, accessibility and quality of care.
7.2 Methods
7.2.1 Definitions
Public hospitals can be either state-owned or fully run by public entities; private ownership can be mission-driven (NFP) or return driven (FP) (Saltman, 2003). The term ‘private’ hospitals will be used as an encompassing term throughout this paper, making no
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