Page 151 - 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
addition, both patients with private health insurance and rural residents are more likely to use private care services (Tountas et al., 2011). Under comparable circumstances FP hospitals generally charge more for admitted patients falling under the Greek Social Health Insurance (SHI) fund (Kondilis et al., 2011). In Greece, more private patients had to pay out- of pocket payments than in public hospitals. On the other hand, and maybe remarkably, “under-the-table” payments were lower in private hospitals (Souliotis et al., 2016).
In Spain, private maternity units/hospitals proportionally treat more patients from higher socio-economic backgrounds (Río et al., 2010; Salvador et al., 2009). In private hospitals the prevalence of caesarean sections was also higher among immigrants in comparison to natives, no such distinctions were found within public hospitals (Salvador et al., 2009). In Italy, patient characteristics differ between private and public (psychiatric) hospitals. Older patients are less likely to be unemployed and make more use of private services (Preti et al., 2009).
Private hospitals are often accused of cream skimming and selecting more profitable patients. We found some illustrations to that suspicion. One Italian study argues that FP hospitals were more involved in cream skimming than both public or NFP hospitals (Berta et al., 2010). In the UK, ISTCs treat less complex NHS patients (Mason et al., 2010; Street et al., 2010). In France, a higher percentage of patients with ambulatory care sensitive conditions visit public hospitals in comparison to private hospitals, while the opposite appears for revascularization. The explanation is that in France public and NFP hospitals account for most acute inpatient stays, and FP hospitals provide half the total revascularizations procedures (Gusmano et al., 2013). Regarding a specific case from Italy, Preti (2010) detected that private psychiatric facilities were less likely to admit patients who attempted suicide prior to admission; this might serve as an indicator that high risk mental health patients are less able to access private services (Preti et al., 2010). Patients in private acute psychiatric inpatient clinics were also more likely to receive a follow-up treatment (i.e. rehabilitation and psychotherapy) (Preti et al., 2009). Bonastre et al. (2014) identified that in France no significant differences exist between public and private hospitals in relation to the use of expensive drugs (anticancer drugs), after controlling for case-mix (Bonastre et al., 2014). One French study investigated if hospital types differed in terms of access to renal (kidney) transplantation. The authors observe that FP hospitals were less likely to have patients on the pre-emptive registration list than (public) academic hospitals, corrected for case-mix differences (Riffaut et al., 2015). Pre-emptive transplantation is associated with longer patient survival. Hence, patients in FP hospitals
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