The Association Between Hospital Financial Performance and the Quality of Care – A Scoping Literature Review

Abstract

Background: Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q). Methods: A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods. Results: 10,503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the US (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies’ results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association. Conclusion: This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in non-US health care settings.

Competencies of hospital managers – A systematic scoping review

“…The geographical distribution of the identified publications indicates a research gap in both theoretical/conceptual and empirical research on hospital manager competencies in European settings. This finding is partly in line with the results of other studies showing that there is a lack of research on hospital financial management in Europe compared to the US ( 75 ). This may be related to the traditionally less market oriented health system structures in European countries and the slower adaptation of most up-to-date management solutions.…”

Hospitals’ financial performance across European countries: a scoping review protocol

“…International research evidence also suggests a positive association between hospital financial performance and quality of care. 12 Yet, the empirical studies are also mostly focused on the US market. 12 At the same time, the available fragmented data indicate that hospitals in many European countries continuously face financial deficits/ insolvency problems: ► The analysis based on a sample of approx.…”

“…12 Yet, the empirical studies are also mostly focused on the US market. 12 At the same time, the available fragmented data indicate that hospitals in many European countries continuously face financial deficits/ insolvency problems: ► The analysis based on a sample of approx. 1500 hospitals from 8 European countries showed that in 2011, 1 in 5 hospitals could be considered high risk in terms of their probability of financial default.…”

“…The US-based studies indicate that a variety of factors (including hospital size, affiliation, payer mix or market concentration) can impact hospital financial standing. International research evidence also suggests a positive association between hospital financial performance and quality of care 12. Yet, the empirical studies are also mostly focused on the US market 12…”

“…International research evidence also suggests a positive association between hospital financial performance and quality of care. 12 Yet, the empirical studies are also mostly focused on the US market. 12 …”