Page 154 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 7
sector (Quercioli et al., 2013). Contrary results indicate that patients in private hospitals are less likely to be readmitted and less likely to die within thirty days after discharge, although the impact of the latter was found to be much lower (Moscone et al., 2012). This corresponds to the results of a multi-level analysis, also from Italy, which assessed that the risk of dying was significantly less in private hospitals (Berta et al., 2013).
Both Pérotin (2013) and Owusu-Frimpong (2010) examine UK patient experiences (Pérotin et al., 2013). The latter study finds that users of ISTCs have higher satisfaction rates, than the users of public facilities for amenities, for instance obtaining attention from doctors (Owusu-Frimpong et al., 2010). However, Pérotin did not find a significant difference on the reported overall patient experiences between public and private clinics. Differences that were found seemed to relate to other variables such as patient characteristics (Pérotin et al., 2013).
This review points to various messages. Findings on efficiency show mixed results, but do suggest that the public sector is at least as or more efficient as the private sector. Many papers mention that the institutional context might be an important constraint for the efficiency for the private sector. For example, Austrian NFP hospitals seem to be ‘induced’ to operate with high levels of operational efficiency. There exists quite some evidence that the private sector seems more sensitive to incentives than the public sector. This was shown for a range of indicators such as responding to changes in demand, upcoding, or adjusting LOS. Differences in LOS seem to depend on type of treatment, whereby consistent evidence shows the private sector has shorter LOS for hip procedures compared to the public sector and type of payment: per diem funding increases LOS in private settings more than in public surroundings, especially for mental health.
7.4 Discussion
As expected, in South European countries and also in the UK where a parallel and partly duplicate system exists between private and public provision, the private sector is used by the more affluent population, who may experience for example lower waiting times and better amenities. This suggests that universal access and a broader inclusion of private providers in the mainstream health system might be an important option to reduce such disparities in access. The same goes for cream-skimming which, although higher in private hospitals, might be prevented by sophisticated case-mix corrections in the payment structures.
Private hospitals may perform better on observable quality outcomes such as for example exist in Germany and Italy for mortality and readmissions. In France, private hospitals specialize in certain (elective) procedures. One might expect better outcomes for
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