Page 145 - 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; this could be a non-profit or for-profit hospital. Papers that include private hospitals as a control variable are also considered to be eligible.
Table 7.2 Inclusion criteria for the second phase
Population
Intervention/ exposure
Outcome
Patients are exposed to the service delivery of private hospitals.
Comparison
A comparison should be made with public hospitals.
One of the following three elements should be covered: efficiency, quality of care and
Study design
accessibility. Articles that only include employment conditions are not taken into consideration.
Empirical research, no descriptive papers or economic modelling are included.
Articles were assessed using a standard format to appraise the quality of the studies (appendix table 7.8). The main criteria for exclusion: 1) research designs were considered to be (extremely) weak; 2) poor reporting on the dataset and methodology, or no possibility of a critical appraisal. The two reviewers only included evidence whereby the quality assessment demonstrated that the findings contributed to our research objective (see Appendix for excluded references). In total thirty-five articles could be included.
A snowballing procedure was carried out in December 2015 and January 2016. Forward snowballing identifies articles that refer to the selected articles in the review. Backward snowballing means that the reference list of the articles were included into the review process. Additionally, the literature selected in other systematic reviews covering the EU was included (Hanratty et al., 2007; Hollingsworth, 2003; Sibbel and Nagarajah, 2012; Tiemann et al., 2012; Torchia et al., 2015). Such a snowballing methodology has been assessed as a successful addition to the systematic review by advocates of realist reviews (Pawson et al., 2005). Articles conceived to be useful upon the PICOS criteria went through the same inclusion process. In total, another ten articles could be included, bringing the total number of studies to forty-five.
The selected articles are summarized in Appendix table 7.9. Thirteen articles originated from Italy, eight from Germany, seven from the United Kingdom (UK), six from France, five from Greece, three from Austria, two from Spain and one from Portugal. While in Germany, Italy, France and Austria most private hospitals act as a substitute for public hospitals, in the UK, Portugal, Spain and Greece, most private hospitals do complement the public system.
7.3 Results
We found twelve articles using productivity functions assessing primarily technical efficiency, three studies also analyzed profit and/or cost efficiency and ten articles reflecting other efficiency measures (e.g. LOS). The evidence on technical efficiency shows no
7.3.1 Efficiency
137