Influence of the management models based on public-private collaboration in the technical and research efficiency of hospitals of the public health system

Abstract

The debate on the sustainability of the public health system has had a growing importance due to the recent economic crisis. Among the most commonly used formulas to ensure sustainability we can find strategies based on public-private collaboration. This paper analyzes different models of hospital management in an area of homogeneous, representative and of high complexity management, such as managed by the Madrid Health Service (SERMAS). It is intended to know if the management models based in public-private collaboration achieve better results of technical and research efficiency of public hospitals. For the evaluation of the efficiency it is used the methodology of the data envelopment analysis (DEA) developed by Charnes et al. (1978) aimed at outputs. The sample is composed of the 25 general hospitals managed by the SERMAS with information obtained from the annual reports for the management of each of the hospitals and relative to the years 2009 to 2016. The results showed a higher level of technical efficiency of the hospitals managed through models based in public-private collaboration with respect to traditional public management, which nevertheless obtained higher results in research efficiency than the hospitals managed through public-private collaboration forms of management. Among the causes of this greater technical efficiency are the greater flexibility in organizational and spending policies as well as greater independence of the management of mixed management hospitals, compared to those of traditional management. In the case of research efficiency, the absence of economic incentives linked to obtaining research results in hospital concession contracts could be one of the main causes of the lower efficiency of hospitals managed through public-private collaboration.