Page 147 - 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
also concluded that NFP hospitals were less efficient in Germany (Herr, 2008; Lindlbauer and Schreyögg, 2014; Tiemann and Schreyögg, 2009). Berta et al. (2010) reveal that Italian FP hospitals are less efficient than their public/non-profit counterparts, but over time have converged towards the same efficiency level as other types (Berta et al., 2010). Similar converging results were found in Germany (Herr et al., 2011). NFP hospitals in Germany and Italy also show convergent efficiency scores according to a total of four studies (Barbetta et al., 2007; Berta et al., 2010; Sommersguter-Reichmann and Stepan, 2015; Tiemann and Schreyögg, 2012). Two studies, from Austria and Germany, reasoned that private providers are more efficient than public hospitals (Czypionka et al., 2014; Tiemann and Schreyögg, 2012). The German study analyzed the process of privatization, whereby hospitals that converted to FP status also increased their efficiency. This indicates that a longitudinal design might show different results than cross-sectional designs. Hospitals that converted to NFP status initially also show increases in efficiency, however, these diminish over time (Tiemann and Schreyögg, 2012). In the case of Portugal, one study concludes that private hospitals were more cost efficient than their public counterparts (Barros et al., 2013). Using a different methodology – non-oriented super efficiency and different sample selection- no difference in efficiency was found (Sommersguter-Reichmann and Stepan, 2015).
Less efficient No difference More efficient
5 studies from Germany & Italy find 2 studies from Germany & Ital y find 1 study from Germany
2009)
3 studies from Germany find private 4 studies from Germany & Italy find no 1 study from Austria
2010)
The overarching message in most studies might actually be the fact that reimbursement schemes are of importance. In Italy, FP hospitals were found to be less efficient because they use resources less efficiently. This might be due to the fact that private for-profit hospitals are confronted with specific regulations that set a limit to the number of funded admissions; since such limits fluctuate over time and are quite volatile. FP hospitals might face problems to adjust fixed input resources accordingly (Daidone and D’Amico, 2009). Another
Table 7.3 Overview technical efficiency of private hospitals compared to public hospitals
FP
private for-profit hospitals less efficient than public hospitals (Daidone and D’Amico, 2009; Herr, 2008; Herwartz and Strumann, 2012; Lindlbauer and Schreyögg, 2014; Tiemann and Schreyögg,
no difference between private for- profit and public hospitals (Berta et al., 2010; Herr et al., 2011)
finds private (for- profit) hospitals to be more efficient than public hospitals (Tiemann and Schreyögg, 2012)
NFP
non-profit hospitals to be less efficient than public (Herr, 2008; Lindlbauer and Schreyögg, 2014; Tiemann and Schreyögg, 2009)
difference between private (non- profit) and public hospitals (Tiemann and Schreyögg, 2012) (Sommersguter- Reichmann and Stepan, 2015) (Barbetta et al., 2007; Berta et al.,
finds private (non- profit) hospitals to be more efficient than public hospitals (Czypionka et al., 2014)
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