Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review

Abstract

SummaryEuropean countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social‐economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for‐profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector.

Do independent treatment centers offer more value than general hospitals? The case of cataract care

“…20 At the same time, findings from both the UK and the US suggest that ITCs might be cherry-picking and treat less-complex patients compared with hospitals. [20][21][22][23][24][25] From the demand side, it seems that the characteristics of patients seeking care from ITCs differ from those of patients seeking care from hospitals. The independent sector in the UK historically serves the interests of private practices of NHS consultants and target a more affluent clientele with additional amenities and shorter waiting lists.…”

“…In contrast, the independent sector in the UK charged higher prices than NHS hospitals (unclear whether this disparity still exists), and evidence points to the fact that ITCs in the UK are not always more efficient—only patients with hip or knee replacements had a shorter length of stay when treated in an ITC . At the same time, findings from both the UK and the US suggest that ITCs might be cherry‐picking and treat less‐complex patients compared with hospitals …”

Determinants of Hospital Efficiency: insights from the literature

“…To the contrary, a study in Germany examining changes in efficiency after privatization demonstrated that conversion from public to private for-profit status resulted in an increase in efficiency between 2.9% and 4.9%, which also appeared to be permanent rather than a transient change [9]. Still others have concluded that there is no clear evidence that private hospital ownership -non-profit and for profits -is associated with higher efficiency compared to public hospital ownership [26,27].…”

La colaboración público-privada en sanidad: hasta dónde y cómo delimitar sus fronteras

“…En otra revisión de este año, etiquetada por los propios autores como «realista», se compara el desempeño de los hospitales públicos con los hospitales privados en cuanto a eficiencia, accesibilidad y calidad de atención en la Unión Europea, sintetizando estudios de Italia, Alemania, Reino Unido, Francia, Grecia, Austria, España y Portugal (Kruse et al, 2018). La mayoría de la evidencia sugiere que los hospitales públicos son al menos tan eficientes o más que los hospitales privados.…”