The Provision of Private Healthcare Services in European Countries: Recent Data and Lessons for Universal Health Coverage in Other Settings

Montagu, Dominic

doi:10.3389/fpubh.2021.636750

Cited by 21 publications

(21 citation statements)

References 20 publications

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“…Because these data are scarce and because different sectors even in the same location have different client mixes and different data collection protocols, there are nearly no ‘apples to apples’ comparisons of the quality of care between sectors that use valid counterfactuals. 15 These statistical issues are unavoidable in administrative data, 25 leading to literatures that produce extremely heterogeneous results in meta-analysis 54 or that rely on intermediate indicators rather than quality outcomes. 55 …”

Section: Discussionmentioning

confidence: 99%

Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India

et al. 2022

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BackgroundThere are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors.MethodsWe used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai.ResultsSPs presented a ‘classic, suspected TB’ scenario and a ‘recurrence or drug-resistance’ scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3).ConclusionsWhile the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India

et al. 2022

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“…Finally, while the contribution of private hospitals to overall delivery of hospital services varies across Europe, 41 findings from this analysis may have implications internationally and may serve as a reminder to policymakers and planners, both in Ireland and elsewhere, of the overall importance, from a system perspective, of understanding future trends in demand for services offered by these providers.…”

Section: Discussionmentioning

confidence: 86%

Projected private hospital expenditure in Ireland, 2018–2035: What role for demographics, cost, and Sláintecare?

Keegan

Brick

Henry

et al. 2021

Health Planning & Management

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Despite private hospitals occupying an important role in the delivery of acute hospital care in Ireland, an understanding of future spending pressures on these services is limited.Particularly, a key dimension of Ireland's ambitious roadmap for healthcare reform (Sláintecare) seeks to remove private practice from public hospitals. However, to date, there has been no examination of how this reform could impact private hospital demand and expenditure, and ultimately, the capacity to treat public patients. Using previously unavailable administrative health insurer data and a healthcare macro-simulation projection model, we project real (volume-based) and nominal expenditure on private hospital services over the medium-term (2018-2035). We develop a number of projection scenarios that vary assumptions in relation to population growth and ageing, healthy ageing, and the future cost of care delivery. Additionally, by developing profiles of private activity in public hospitals, we examine how the removal of private practice from public hospitals could impact on demand and expenditure in private hospitals over time.Findings from this analysis have implications for capital investment and workforce planning in private hospitals, and failure to meet future demand could have implications for access to care in public hospitals. Moreover, should private practice be ended in public hospitals, most complex private in-patient and emergency care is likely to remain within the public hospitals with limited capacity benefits for the public system.

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“…1,2 Public and private health service providers coexist in most nations in the region, although there are significant differences in the scale and scope of the private sector, both across and within countries. [1][2][3][4][5] The traditional argument in favor of the private health sector has been competition in the market, which in theory should favor better performance. 1,2 Commonly debated weaknesses in public health management include the lack of sufficient incentives to improve performance, absence of risk of bankruptcy, and lack of accountability to shareholders/owners.…”

Section: Introductionmentioning

confidence: 99%

Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries

Lazzerini

Valente

Covi

et al. 2022

Intl J Gynecology & Obste

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Objective To explore the quality of maternal and newborn care (QMNC) during the COVID‐19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean. Methods Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities. Results Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52–1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65–2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14–1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone. Conclusion The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high‐quality care, independent of facility type or geographical distribution. ClinicalTrials.gov Identifier NCT04847336

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The Provision of Private Healthcare Services in European Countries: Recent Data and Lessons for Universal Health Coverage in Other Settings

Cited by 21 publications

References 20 publications

Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India

Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India

Projected private hospital expenditure in Ireland, 2018–2035: What role for demographics, cost, and Sláintecare?

Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries

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