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Comparing public and private providers: a scoping review of hospital services in Europe

BACKGROUND: What is common to many healthcare systems is a discussion about the optimal balance between public and private provision. This paper provides a scoping review of research comparing the performance of public and private hospitals in Europe. The purpose is to summarize and compare research...

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Autores principales: Tynkkynen, Liina-Kaisa, Vrangbæk, Karsten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828324/
https://www.ncbi.nlm.nih.gov/pubmed/29482564
http://dx.doi.org/10.1186/s12913-018-2953-9
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author Tynkkynen, Liina-Kaisa
Vrangbæk, Karsten
author_facet Tynkkynen, Liina-Kaisa
Vrangbæk, Karsten
author_sort Tynkkynen, Liina-Kaisa
collection PubMed
description BACKGROUND: What is common to many healthcare systems is a discussion about the optimal balance between public and private provision. This paper provides a scoping review of research comparing the performance of public and private hospitals in Europe. The purpose is to summarize and compare research findings and to generate questions for further studies. METHODS: The review was based on a methodological approach inspired by the British EPPI-Centre’s methodology. This review was broader than review methodologies used by Cochrane and Campbell and included a wider range of methodological designs. The literature search was performed using PubMed, EconLit and Web of Science databases. The search was limited to papers published from 2006 to 2016. The initial searches resulted in 480 studies. The final sample was 24 papers. Of those, 17 discussed economic effects, and seven studies addressed quality. RESULTS: Our review of the 17 studies representing more than 5500 hospitals across Europe showed that public hospitals are most frequently reported as having the best economic performance compared to private not-for-profit (PNFP) and private for-profit (PFP) hospitals. PNFP hospitals are second, while PFP hospitals are least frequently reported as superior. However, a sizeable number of studies did not find significant differences. In terms of quality, the results are mixed, and it is not possible to draw clear conclusions about the superiority of an ownership type. A few studies analyzed patient selection. They indicated that public hospitals tend to treat patients who are slightly older and have lower socioeconomic status, riskier lifestyles and higher levels of co-morbidity and complications than patients treated in private hospitals. CONCLUSIONS: The paper points to shortcomings in the available studies and argues that future studies are needed to investigate the relationship between contextual circumstances and performance. A big weakness in many studies addressing economic effects is the failure to control for quality and other operational dimensions, which may have influenced the results. This weakness should also be addressed in future comparative studies.
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spelling pubmed-58283242018-02-28 Comparing public and private providers: a scoping review of hospital services in Europe Tynkkynen, Liina-Kaisa Vrangbæk, Karsten BMC Health Serv Res Research Article BACKGROUND: What is common to many healthcare systems is a discussion about the optimal balance between public and private provision. This paper provides a scoping review of research comparing the performance of public and private hospitals in Europe. The purpose is to summarize and compare research findings and to generate questions for further studies. METHODS: The review was based on a methodological approach inspired by the British EPPI-Centre’s methodology. This review was broader than review methodologies used by Cochrane and Campbell and included a wider range of methodological designs. The literature search was performed using PubMed, EconLit and Web of Science databases. The search was limited to papers published from 2006 to 2016. The initial searches resulted in 480 studies. The final sample was 24 papers. Of those, 17 discussed economic effects, and seven studies addressed quality. RESULTS: Our review of the 17 studies representing more than 5500 hospitals across Europe showed that public hospitals are most frequently reported as having the best economic performance compared to private not-for-profit (PNFP) and private for-profit (PFP) hospitals. PNFP hospitals are second, while PFP hospitals are least frequently reported as superior. However, a sizeable number of studies did not find significant differences. In terms of quality, the results are mixed, and it is not possible to draw clear conclusions about the superiority of an ownership type. A few studies analyzed patient selection. They indicated that public hospitals tend to treat patients who are slightly older and have lower socioeconomic status, riskier lifestyles and higher levels of co-morbidity and complications than patients treated in private hospitals. CONCLUSIONS: The paper points to shortcomings in the available studies and argues that future studies are needed to investigate the relationship between contextual circumstances and performance. A big weakness in many studies addressing economic effects is the failure to control for quality and other operational dimensions, which may have influenced the results. This weakness should also be addressed in future comparative studies. BioMed Central 2018-02-27 /pmc/articles/PMC5828324/ /pubmed/29482564 http://dx.doi.org/10.1186/s12913-018-2953-9 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Tynkkynen, Liina-Kaisa
Vrangbæk, Karsten
Comparing public and private providers: a scoping review of hospital services in Europe
title Comparing public and private providers: a scoping review of hospital services in Europe
title_full Comparing public and private providers: a scoping review of hospital services in Europe
title_fullStr Comparing public and private providers: a scoping review of hospital services in Europe
title_full_unstemmed Comparing public and private providers: a scoping review of hospital services in Europe
title_short Comparing public and private providers: a scoping review of hospital services in Europe
title_sort comparing public and private providers: a scoping review of hospital services in europe
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828324/
https://www.ncbi.nlm.nih.gov/pubmed/29482564
http://dx.doi.org/10.1186/s12913-018-2953-9
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