Administration of Strategic Agreements in Public Hospitals: Considerations to Enhance the Quality and Sustainability of Mergers and Acquisitions

Monteros, Javier Cerezo-Espinosa de Los; Castro-Torres, Antonio; Gómez‐Salgado, Juan; Fagundo-Rivera, Javier; Gómez-Salgado, Carlos; Coronado-Vázquez, Valle

doi:10.3390/ijerph18084051

Cited by 4 publications

(5 citation statements)

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“…Through the disappearance, following a merger, of some formal organizational structures, states of stress and conflict may arise, felt by some employees as a sense of loss, pain and sometimes anger related to the loss of old identities and values (Ivancevich et al, 1987 ; Sutton, 1987 ; Sanda and Adjei-Benin, 2011 ). Hospital mergers have a significant effect on employee sick leave frequency both in the short term and 2–4 years after the merger (Bourbonnais et al, 2005 ; Kjekshus et al, 2014 ; Ingelsrud, 2017 ; Cerezo-Espinosa de los Monteros et al, 2021 ). There is evidence of increased incidence of psychosocial stress, risk of depression, anxiety, sleep disturbances and a higher rate of retirement among staff early in the merger process (Breinegaard et al, 2017 ; Cerezo-Espinosa de los Monteros et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…Hospital mergers have a significant effect on employee sick leave frequency both in the short term and 2–4 years after the merger (Bourbonnais et al, 2005 ; Kjekshus et al, 2014 ; Ingelsrud, 2017 ; Cerezo-Espinosa de los Monteros et al, 2021 ). There is evidence of increased incidence of psychosocial stress, risk of depression, anxiety, sleep disturbances and a higher rate of retirement among staff early in the merger process (Breinegaard et al, 2017 ; Cerezo-Espinosa de los Monteros et al, 2021 ). After the merger, lower job satisfaction is associated with high turnover among medical staff (Cerezo-Espinosa de los Monteros et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…There is evidence of increased incidence of psychosocial stress, risk of depression, anxiety, sleep disturbances and a higher rate of retirement among staff early in the merger process (Breinegaard et al, 2017 ; Cerezo-Espinosa de los Monteros et al, 2021 ). After the merger, lower job satisfaction is associated with high turnover among medical staff (Cerezo-Espinosa de los Monteros et al, 2021 ). The negative effect is no longer statistically significant after one year (Kjekshus et al, 2014 ; Cerezo-Espinosa de los Monteros et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…After the merger, lower job satisfaction is associated with high turnover among medical staff (Cerezo-Espinosa de los Monteros et al, 2021 ). The negative effect is no longer statistically significant after one year (Kjekshus et al, 2014 ; Cerezo-Espinosa de los Monteros et al, 2021 ). Staff job satisfaction can be ensured by the fulfillment of expectations related to the benefits of the merger (Bourbonnais et al, 2005 ; Kjekshus et al, 2014 ; Lim, 2014 ; Cerezo-Espinosa de los Monteros et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…A study published in 2014 analyzing the influence of structural changes in the Italian National Health Service concludes that overall job satisfaction is influenced by these changes (Mascia et al, 2014 ). Increased job satisfaction immediately after the merger is associated with pre-merger employee engagement (Cerezo-Espinosa de los Monteros et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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The influence of the merger process between two tertiary hospitals in Romania on job satisfaction among staff

Ilea,

Daina,

Manole

et al. 2024

Front. Psychol.

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AimThe purpose of this study is to evaluate the influence of the merger process of two tertiary hospitals located in the northwest of Romania on the professional satisfaction among medical and non-medical staff and to develop a standardized satisfaction questionnaire for romanian hospitals.Methods1750 questionnaires distributed within County Clinical Emergency Hospital Bihor (CCEHBh) ten months and one year and four months after the merger process were analyzed.ResultsThe percentage of staff who declare themselves satisfied with their work one year and four months after the merger is 80.14%. It has a downward trend compared to the result measured 10 months after the merger (86.14%) (χ2 test, p < 0.01). The aspects that were rated with the lowest percentage as satisfactory were the possibility of promotion (41.89%) and job security (53.38%). A statistically significant decrease was also recorded in the assessment of career prospects (from 81.49% to 74.73%, χ2 test, p < 0.0001).ConclusionsEven if there was a decrease in job satisfaction between the two evaluated periods, we can state that the general level at the last measurement is a good one (4.07 out of a maximum of 5). There was no significant difference in job satisfaction 1 year and 4 months after the merger for staff in the merged unit (4.06) compared to staff in the absorbing unit (4.09). The questionnaire applied in 2023 is one that has proven validity and reliability, being a good starting point for creating a standardized questionnaire that could be implemented in the vast majority of hospitals in Romania. The application of the questionnaire at an interval of 3–6 months would highlight the result of the implemented measures and the trend of employee satisfaction within CCEHBh.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The influence of the merger process between two tertiary hospitals in Romania on job satisfaction among staff

Ilea,

Daina,

Manole

et al. 2024

Front. Psychol.

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Market concentration of the Brazilian hospital medical supplementary health system

Westarb Cruz,

Gomide,

Tuon

et al. 2024

BMC Health Serv Res

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Background The Brazilian supplementary health market has undergone transformations in recent years due to constant mergers and acquisitions of by large corporations, contributing to the increase in market concentration, especially in the poorest and least developed regions of the country. Thus, given the care it provides and its economic relevance, understanding the fundamentals of these movements, the likely consequences and trends for the health market are relevant, important, and strategic. Objective To understand the general and specific context of Brazilian supplementary health, its scenarios, and trends, with emphasis on the analysis of market concentration and recent mergers and acquisitions. Methodology The research is applied, descriptive and exploratory and uses secondary data from various sources, submitted to quantitative data analysis methods. The data are organized into three groups: historical and regulatory documents; industry data; and market. Results The results show the growing concentration of the market promoted by large publicly traded corporations, the growing relevance of tech startups on the healthcare landscape, the predominant use of the relative valuation model, with implicit multiples for asset pricing and the prevalence of corporate health plans. Conclusion The growing concentration of the system projects a market with fewer options and less competitiveness, since the growth of large operators is evident, in addition to the relevant increase in the number of complaints from users of the system, which signals the growing gap between the expectations of users and the levels of quality care offered. The study also highlights the predominance of corporate health plans, revealing the direct relationship between access to supplementary health services and employability rates. The analysis of M&A operations, in addition to the increase in market concentration, reveals the prevalence of the use of the relative valuation model and implicit multiples for the pricing of traded assets. This denotes the future expectation of wealth generation, at least equivalent to the historical series of the sector, on the part of investors, whose frustration may signal the decreasing attractiveness of resources and M&A operations in the sector in the coming years.

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Market Concentration of the Brazilian Hospital Medical Supplementary Health System.

Cruz,

Gomide,

Tuon

et al. 2023

Preprint

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Background The Brazilian supplementary health market has undergone transformations in recent years due to constant mergers and acquisitions of by large corporations, contributing to the increase in market concentration, especially in the poorest and least developed regions of the country. This could affect conditions for access and the quality of services provided. Thus, given the care it provides and its economic relevance, understanding the fundamentals of these movements, the likely consequences and trends for the health market are relevant, important, and strategic. Objective to understand the general and specific context of Brazilian supplementary health, its scenarios, and trends, with emphasis on the analysis of market concentration and recent mergers and acquisitions. Methodology: The research is applied, descriptive and exploratory and uses secondary data from various sources, submitted to quantitative data analysis methods. The object of the research is the history of supplementary health in Brazil, its main players and the recent market movements promoted by mergers and acquisitions. The data are organized into three groups, each with its own collection and analysis approach. The first group, Historical and Regulatory Documents, allows the analysis of the relevance and history of the supplementary health sector in the Brazilian context. The second group, Industry Data, presents a descriptive statistical analysis and enables an understanding of the historical series of the evolution of the sector and the measurement of market concentration indices. The third group, Market, allows an analysis of relational networks using Ucinet software. Results The results show the growing concentration of the market promoted by large publicly traded corporations, the growing relevance of tech startups on the healthcare landscape, the predominant use of the relative valuation model, with implicit multiples for asset pricing, and the prevalence of corporate health plans in the Brazilian market. Conclusion The growing concentration of the Brazilian supplementary health system projects a market with fewer options and less competitiveness, since the growth of large operators is evident, in addition to the relevant increase in the number of complaints from users of the system, which signals the growing gap between the expectations of users and the levels of quality care offered. It also emphasizes the urgent need for attention and action from regulatory agencies to guarantee levels of competition, competitiveness and quality. The study also highlights the predominance of corporate health plans, revealing the direct relationship between access to supplementary health services and employability rates. The analysis of M&A operations, in addition to the increase in market concentration, reveals the prevalence of the use of the relative valuation model and implicit multiples for the pricing of traded assets. this denotes the future expectation of wealth generation, at least equivalent to the historical series of the sector, on the part of investors, whose frustration may signal the decreasing attractiveness of resources and M&A operations in the sector in the coming years.

show abstract

Administration of Strategic Agreements in Public Hospitals: Considerations to Enhance the Quality and Sustainability of Mergers and Acquisitions

Cited by 4 publications

References 61 publications

The influence of the merger process between two tertiary hospitals in Romania on job satisfaction among staff

The influence of the merger process between two tertiary hospitals in Romania on job satisfaction among staff

Market concentration of the Brazilian hospital medical supplementary health system

Market Concentration of the Brazilian Hospital Medical Supplementary Health System.

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