Incorporation of public hospitals: A “Silver Bullet” against overcapacity, managerial bottlenecks and resource constraints?

Fidler, Armin; Haslinger, Reinhard R.; Hofmarcher, Maria M.; Jesse, Maris; Palu, Toomas

doi:10.1016/j.healthpol.2006.06.007

Cited by 30 publications

(27 citation statements)

References 14 publications

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“…Fidler et al [74] analysed a decade of experience in Austria and Estonia in restructuring and reorganizing hospital care. In these countries, the incorporation of hospitals and horizontal integration through the creation of holding companies or hospital networks under private law was a viable tool to combine market incentives for management while maintaining public ownership and at the same time achieving efficiency gains and economies of scale.…”

Section: Resultsmentioning

confidence: 99%

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

Giancotti¹,

Guglielmo²,

Mauro³

2017

PLoS ONE

116

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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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Section: Resultsmentioning

confidence: 99%

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

Giancotti¹,

Guglielmo²,

Mauro³

2017

PLoS ONE

116

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“…His preference was for the creation of ''… a parallel private system, funded by voluntary insurance'' that would ''… relieve the overstressed public system without decreasing the quality of care in that system.'' [9, p. 408] The Impact of Privatization and Corporatization is Often Lower than Expected and the Evidence is Hard to find In essence, then, our analysis suggests that the impact of privatization and corporatization on public hospitals is often less than envisaged by proponents at the outset, there is a limited range of well-designed scientific evaluations, much of the work is of a case comparison type [14], evaluation lags implementation often by substantial time periods, and thus views from the literature must be treated cautiously. Claims are often made that privatization and corporatization will lead, a priori, to improvements in efficiency.…”

Section: Advantages and Disadvantages Of Corporatizationmentioning

confidence: 82%

Can Questions of the Privatization and Corporatization, and the Autonomy and Accountability of Public Hospitals, Ever be Resolved?

2010

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Although there is a long-standing international debate concerning the privatization and corporatization of health services, there has been relatively little systematic analysis of the ways these types of reform manifest. We examine the impact of privatization and corporatization on public hospitals, and in particular on hospitals' autonomy and accountability, with two aims: to uncover the key themes in the literature, and to consider implementation issues. The review of 2,319 articles was conducted using content analysis and a discussion of selected key issues. Several major themes appear in the privatization and corporatization literature, including their use as tools in health systems reform, and the role of governments in sponsoring the processes. We show that much of the underlying argument is ideological rather than evidence based. Those who promote versions of privatization or corporatization claim that decreased government involvement in the management of hospitals leads inter alia to benefits such as greater efficiency, better quality services, and increased choice for patients. Those who argue against say that increased privatization leads to deleterious outcomes such as decreased equity, compromised efficiency and poorer quality of care. The evidence is often weak and at times conflicting. Privatization and corporatization are difficult to implement, and at best produce mixed results, and their impact seems to depend more on the motivation of the evaluator than the standard of the results. These debates are of a type that is to a large extent only resolvable ideologically.

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“…However, in many health systems it is difficult to determine whether the organizations involved in the purchase or provision of health care are public, private or somewhere in between. Mixed public and private cases have arisen in the United Kingdom where primary care trusts both purchase and provide long-term care services to public and private patients [36], in public hospitals in Finland offering private health services at below market rates [37], and semi-privatized public hospitals in Germany [38] and Austria [39]. There are also a number of public-private partnerships (PPP) that have developed in post-communist states [40].…”

Section: Undertakings or Public Service Organizationsmentioning

confidence: 99%