The challenge of corporatisation: the experience of Portuguese public hospitals

Rêgo, Guilhermina; Nunes, Rui; Costa, Jorge Moreira da

doi:10.1007/s10198-009-0198-6

Cited by 61 publications

(46 citation statements)

References 37 publications

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“…On the other hand we included other variables that have been reported in hospital cost function estimation literature, such as the average length of stay [24, 25]. …”

Section: Resultsmentioning

confidence: 99%

Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery

Stenberg

Lauer

Gkountouras

et al. 2018

Cost Eff Resour Alloc

103

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BackgroundPolicy makers require information on costs related to inpatient and outpatient health services to inform resource allocation decisions.MethodsCountry data sets were gathered in 2008–2010 through literature reviews, website searches and a public call for cost data. Multivariate regression analysis was used to explore the determinants of variability in unit costs using data from 30 countries. Two models were designed, with the inpatient and outpatient models drawing upon 3407 and 9028 observations respectively. Cost estimates are produced at country and regional level, with 95% confidence intervals.ResultsInpatient costs across 30 countries are significantly associated with the type of hospital, ownership, as well as bed occupancy rate, average length of stay, and total number of inpatient admissions. Changes in outpatient costs are significantly associated with location, facility ownership and the level of care, as well as to the number of outpatient visits and visits per provider per day.ConclusionsThese updated WHO-CHOICE service delivery unit costs are statistically robust and may be used by analysts as inputs for economic analysis. The models can predict country-specific unit costs at different capacity levels and in different settings.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0095-x) contains supplementary material, which is available to authorized users.

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“…On the other hand we included other variables that have been reported in hospital cost function estimation literature, such as the average length of stay [24, 25]. …”

Section: Resultsmentioning

confidence: 99%

Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery

Stenberg

Lauer

Gkountouras

et al. 2018

Cost Eff Resour Alloc

103

View full text Add to dashboard Cite

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“…Authors provided insights into how hospitals responded to the pressure for increased efficiency and quality introduced by the reforms by the adoption of management contracts [70, 71] and by the introduction of the DRG-based payment system [72]. Results showed an improvement in hospital performance primarily driven by quality increases.…”

Section: Resultsmentioning

confidence: 99%

“…Specifically, 14 articles analysed technical and scale efficiency using a sample composed of General/Acute-care and Teaching Hospitals. Two articles conducted analyses within a sample composed of district, regional, psychiatric and specialized hospitals [63], and by central, district and level 1 hospitals (level 1 hospitals provide a limited range of specialties and refer patients to other types of hospitals) [71]. …”

Section: Resultsmentioning

confidence: 99%

Efficiency and optimal size of hospitals: Results of a systematic search

Giancotti¹,

Guglielmo²,

Mauro³

2017

PLoS ONE

122

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BackgroundNational Health Systems managers have been subject in recent years to considerable pressure to increase concentration and allow mergers. This pressure has been justified by a belief that larger hospitals lead to lower average costs and better clinical outcomes through the exploitation of economies of scale. In this context, the opportunity to measure scale efficiency is crucial to address the question of optimal productive size and to manage a fair allocation of resources.Methods and findingsThis paper analyses the stance of existing research on scale efficiency and optimal size of the hospital sector. We performed a systematic search of 45 past years (1969–2014) of research published in peer-reviewed scientific journals recorded by the Social Sciences Citation Index concerning this topic. We classified articles by the journal’s category, research topic, hospital setting, method and primary data analysis technique. Results showed that most of the studies were focussed on the analysis of technical and scale efficiency or on input / output ratio using Data Envelopment Analysis. We also find increasing interest concerning the effect of possible changes in hospital size on quality of care.ConclusionsStudies analysed in this review showed that economies of scale are present for merging hospitals. Results supported the current policy of expanding larger hospitals and restructuring/closing smaller hospitals. In terms of beds, studies reported consistent evidence of economies of scale for hospitals with 200–300 beds. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds.

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“…Several theories, including property rights and contract failure approaches as well as public choice theory, explain differences in hospitals' objectives according to their ownership type. Namely, for-profit hospitals have high incentives to maximize profits, non-profit organizations are driven by mission fulfillment, and public hospitals focus on fulfilling public tasks, particularly the comprehensive provision of care [3,43]. As postulated by the internal congruence model, objectives affect strategic choices, which implies a link between ownership and strategy type.…”

Section: Structural Differences Across the Strategy Typesmentioning

confidence: 99%