Influence of the management models based on public-private collaboration in the technical and research efficiency of hospitals of the public health system

Abstract

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.

Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals

“…Some of the main challenges currently faced by health systems in developed countries are the coverage of the health care needs of an increasingly ageing population, with a multitude of chronic diseases and the growing costs of technological innovation. The recent worldwide financial crisis, and the consequent budget restrictions on the provision of state services, has encouraged public health systems to develop various strategies to make management more flexible, in order to guarantee financial sustainability [1]. The introduction of public-private partnership (PPP) formulas stands out among these new measures.…”

The efficiency of provincial government health care expenditure after China’s new health care reform

“…Health care system efficiency has been extensively researched, but previous studies have a number of defects: firstly, they were mostly based on cross-sectional data for efficiency accounting, and this makes it impossible to analyze the trend of dynamic efficiency change in government health care expenditure [ 10 , 24 , 27 , 37 , 49 , 50 ]; secondly, a number of contributions to the literature take health outcomes, such as life expectancy and child mortality, as output variables when calculating the efficiency of health care system; however, various health care resources are the most direct output of government health care expenditure [ 51 ]. The complexity of the health decision process means that using health outcomes as an output of government health care expenditure will inevitably introduce more bias, and this will affect the accuracy of the accounting results.…”