SummaryFundamentalsThe study aims to carry out a comparative analysis of the technical efficiency of hospital management based on public‐private collaboration, as compared with traditional management. Specifically, we compare traditionally managed public hospitals, public hospitals managed by a private finance initiative (PFI), public hospitals managed through a public‐private partnership (PPP), and hospitals managed through other forms of management, during the period 2009 to 2014, in the hospitals dependent on the Madrid Health Service (SERMAS).MethodsThe study covers all publicly owned general hospitals under SERMAS, consisting of seven PFI hospitals, three PPP hospitals, 11 traditionally managed public hospitals (with the category of general hospital), and four hospitals managed through other forms of hospital management. The technical efficiency indices of the hospitals were calculated using the data envelopment analysis technique. Subsequently, a sensitivity analysis was performed by bootstrapping and variation of model variables to verify their impact on efficiency. Finally, an analysis of the evolution of efficiency in the analyzed period was carried out using the Malmquist Index.ResultsIn all the analysis models carried out in the analyzed period, the hospitals managed based on public‐private collaboration were more efficient than the hospitals under traditional management.ConclusionsThe greater efficiency of hospitals managed based on public‐private collaboration, as compared with traditional management, could be attributed to greater organizational and management flexibility.

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Background The aim of this paper is to analyze the differences in the coordination of chronic illness care between the different public hospital management models coexisting in the Spanish region of Madrid (25 hospitals) during the period 2013–2017. Methods The performance of hospitals might be affected by the characteristics of the population they serve and, therefore, this information should be taken into account when estimating efficiency measures. For this purpose, we apply the nonparametric Data Envelopment Analysis (DEA) conditioned to some contextual variables and adapted to a dynamic framework, so that we can assess hospitals during a five-year period. The outputs considered are preventable hospitalizations, readmissions for heart failure and readmissions for chronic obstructive pulmonary disease, whereas the inputs considered are the number of beds, personnel (physicians and other healthcare professionals) and total expenditure on goods and services. Results The results suggest that the level of efficiency demonstrated by the public-private collaboration models of hospital management is higher than traditionally managed hospitals throughout the analyzed period. Nevertheless, we notice that efficiency differences among hospitals are significantly reduced when contextual factors were taken into account. Conclusions Hospitals managed under public-private collaboration models are more efficient than those under traditional management in terms of chronic illness care coordination, being this difference attributable to more agile and flexible management under the collaborative models.

El debate sobre la sostenibilidad del sistema sanitario público ha tenido una progresiva importancia debido a la reciente crisis económica. Entre las fórmulas más utilizadas para garantizar la sostenibilidad se encuentran las estrategias basadas en la colaboración público-privada. Este trabajo analiza diversas formas de gestión de hospitales públicos en un área de gestión homogénea, representativa y de elevada complejidad, como es la gestionada por el Servicio Madrileño de Salud (SERMAS). Se pretende conocer si la gestión basada en la colaboración público-privada obtiene mejores resultados de eficiencia técnica e investigadora.Se utiliza la metodología del análisis envolvente de datos (AED) desarrollada por Charnes et al (1978) orientada a outputs. La muestra está formada por los 25 hospitales generales gestionados por el SERMAS, con información obtenida de las memorias anuales de gestión de cada uno de los hospitales y relativa a los años 2009 a 2016. Los resultados evidenciaron una mayor eficiencia técnica de las formas de gestión de hospitales públicos basadas en la colaboración público-privada respecto a la gestión pública tradicional, que sin embargo, obtuvo resultados superiores en eficiencia investigadora a los obtenidos por las formas de gestión de hospitales basadas en la colaboración público-privada. Entre las causas de esta mayor eficiencia técnica, se encuentran la mayor flexibilidad en políticas organizativas y de gasto, así como una mayor independencia de la gerencia de los hospitales de gestión mixta, frente a los de gestión tradicional. En el caso de la eficiencia investigadora, la ausencia de incentivos económicos ligados a la obtención de resultados en investigación en los contratos de concesión de hospitales podría ser una de las principales causas de la menor eficiencia de los hospitales gestionados mediante colaboración público-privada. The debate on the sustainability of the public health system has had a growing importance due to the recent economic crisis. Among the most commonly used formulas to ensure sustainability we can find strategies based on public-private collaboration.This paper analyzes different models of hospital management in an area of homogeneous, representative and of high complexity management, such as managed by the Madrid Health Service (SERMAS).It is intended to know if the management models based in public-private collaboration achieve better results of technical and research efficiency of public hospitals.For the evaluation of the efficiency it is used the methodology of the data envelopment analysis (DEA) developed by Charnes et al (1978) aimed at outputs. The sample is composed of the 25 general hospitals managed by the SERMAS with information obtained from the annual reports for the management of each of the hospitals and relative to the years 2009 to 2016.The results showed a higher level of technical efficiency of the hospitals managed through models based in public-private collaboration with respect to traditional public management, which nevertheless obtained higher results in research efficiency than the hospitals managed through public-private collaboration forms of management. Among the causes of this greater technical efficiency are the greater flexibility in organizational and spending policies as well as greater independence of the management of mixed management hospitals, compared to those of traditional management. In the case of research efficiency, the absence of economic incentives linked to obtaining research results in hospital concession contracts could be one of the main causes of the lower efficiency of hospitals managed through public-private collaboration.

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