Page 143 - 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
distinction between NPF and FP. To compare public and private hospitals, this review will investigate three umbrella outcomes: 1) efficiency, 2) accessibility, and 3) quality of care. Efficiency holds the notion as the extent to which objectives are achieved in relation to the resources consumed (Jacobs et al., 2006). This includes both productivity measures based upon frontier analysis or other regression based approached, efficiency ratios (e.g. employment ratios) and other efficiency outcomes such as length of stay (LOS) or responsiveness to demand. The most applied productivity methods are the Stochastic Frontier Analysis (SFA) and the Data Envelopment Analysis (DEA)(Hollingsworth, 2003; Tiemann et al., 2012). Efficiency measures are reflected in multiple indicators such as technical efficiency (maximum output from a given set of inputs or a minimum set of inputs with a given set of outputs), cost efficiency (technical efficiency accounting for the input price), scale efficiency (when the size of the unit is at its optimum) and/or allocative/profit efficiency (cost minimization or profit maximisation) (Coelli et al., 2005). Accessibility is categorized into financial affordability, physical access, informed access, as well as timely access (e.g. waiting times) (Dubois and Anderson, 2013). Quality of care is structured along the lines of the Donabedian model of structure, process and outcomes (Donabedian, 1988). Some studied indicators, such as LOS, can be classified under different domains within the Donabedian framework. Based upon consultations during two expert meetings, such indicators were classified towards the most suitable domain. Another difficulty arises with practice variation. To illustrate; does a high rate of surgical treatments indicate better or poor quality of care? To avoid the complex discussion on practice variation and the ambiguous relationship with quality of care, this review does not look into variation in practices.
Our study follows a realist review approach. A realistic review is suited to review interventions that are embedded in complex systems, whereby outcomes are dependent and influenced by their contexts (Pawson et al., 2005). Rationales and drivers behind the implementation or growth of the private sector are diverse. Due to the peculiar nature of our ‘intervention’, minor deviations from the realist review protocol were necessary (i.e. no explicit distinction is made between intervention, context and mechanism). This review limits its territory to the EU (28 countries), because the EU countries are, to a certain extent, comparable but have various health care systems. The variety of health care systems can be used to explore how private hospitals perform within various settings. We strive towards a review that “delivers illumination rather than generalizable truths and contextual fine-
7.2.2 Realist Review
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