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Does Ownership Matter? An Overview of Systematic Reviews of the Performance of Private For-Profit, Private Not-For-Profit and Public Healthcare Providers

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  • Cristian A Herrera
  • Gabriel Rada
  • Lucy Kuhn-Barrientos
  • Ximena Barrios

Abstract

Introduction: Ownership of healthcare providers has been considered as one factor that might influence their health and healthcare related performance. The aim of this article was to provide an overview of what is known about the effects on economic, administrative and health related outcomes of different types of ownership of healthcare providers -namely public, private non-for-profit (PNFP) and private for-profit (PFP)- based on the findings of systematic reviews (SR). Methods and Findings: An overview of systematic reviews was performed. Different databases were searched in order to select SRs according to an explicit comprehensive criterion. Included SRs were assessed to determine their methodological quality. Of the 5918 references reviewed, fifteen SR were included, but six of them were rated as having major limitations, so they weren't incorporated in the analyses. According to the nine analyzed SR, ownership does seem to have an effect on health and healthcare related outcomes. In the comparison of PFP and PNFP providers, significant differences in terms of mortality of patients and payments to facilities have been found, both being higher in PFP facilities. In terms of quality and economic indicators such as efficiency, there are no concluding results. When comparing PNFP and public providers, as well as for PFP and public providers, no clear differences were found. Conclusion: PFP providers seem to have worst results than their PNFP counterparts, but there are still important evidence gaps in the literature that needs to be covered, including the comparison between public and both PFP and PNFP providers. More research is needed in low and middle income countries to understand the impact on and development of healthcare delivery systems.

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  • Cristian A Herrera & Gabriel Rada & Lucy Kuhn-Barrientos & Ximena Barrios, 2014. "Does Ownership Matter? An Overview of Systematic Reviews of the Performance of Private For-Profit, Private Not-For-Profit and Public Healthcare Providers," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-18, December.
    • Handle: RePEc:plo:pone00:0093456
    DOI: 10.1371/journal.pone.0093456
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    References listed on IDEAS

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    1. Sima Berendes & Peter Heywood & Sandy Oliver & Paul Garner, 2011. "Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies," PLOS Medicine, Public Library of Science, vol. 8(4), pages 1-10, April.
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    1. Belfiore, Alessandra & Cuccurullo, Corrado & Aria, Massimo, 2022. "Financial configurations of Italian private hospitals: an evolutionary analysis," Health Policy, Elsevier, vol. 126(7), pages 661-667.
    2. Anita Golovkova, 2020. "IFRS implementation in healthcare facilities in the United Kingdom: (un)intended effects [Implementace IFRS ve zdravotnických zařízeních ve Velké Británii - (ne)zamyšlené dopady]," Český finanční a účetní časopis, Prague University of Economics and Business, vol. 2020(3-4), pages 53-70.
    3. Martin Chalkley, 2018. "Private Provision of Publicly Funded Health Care: The Economics of Ownership," Briefing 002055, Office of Health Economics.
    4. Besley, Timothy & Malcomson, James M., 2018. "Competition in public service provision: The role of not-for-profit providers," Journal of Public Economics, Elsevier, vol. 162(C), pages 158-172.
    5. Kraska, Rike Antje & Krummenauer, Frank & Geraedts, Max, 2016. "Impact of public reporting on the quality of hospital care in Germany: A controlled before–after analysis based on secondary data," Health Policy, Elsevier, vol. 120(7), pages 770-779.
    6. Anita Golovkova, 2020. "IFRS implementation in healthcare facilities in the United Kingdom: (un)intended effects [Implementace IFRS ve zdravotnických zařízeních ve Velké Británii – (ne)zamyšlené dopady]," Český finanční a účetní časopis, Prague University of Economics and Business, vol. 2020(3-4).
    7. Levaggi, Laura & Levaggi, Rosella, 2023. "Competition in the provision of hospital care: Are mixed markets a valid alternative?," Economic Modelling, Elsevier, vol. 127(C).
    8. Alvaro S Almeida, 2016. "The Role Of Private Non-Profit Healthcare Organizations In Nhs Systems: Implications For The Portuguese Hospital Devolution Program," FEP Working Papers 577, Universidade do Porto, Faculdade de Economia do Porto.
    9. Levaggi, Laura & Levaggi, Rosella, 2020. "Is there scope for mixed markets in the provision of hospital care?," Social Science & Medicine, Elsevier, vol. 247(C).
    10. Siciliani, Luigi & Chalkley, Martin & Gravelle, Hugh, 2017. "Policies towards hospital and GP competition in five European countries," Health Policy, Elsevier, vol. 121(2), pages 103-110.
    11. Manish Mittal & Chih-Hsiung E Wang & Abigail H Goben & Andrew D Boyd, 2018. "Proprietary management and higher readmission rates: A correlation," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-8, September.
    12. Kao, Chiang & Pang, Rui-Zhi & Liu, Shiang-Tai & Bai, Xue-Jie, 2021. "Most productive types of hospitals: An empirical analysis," Omega, Elsevier, vol. 99(C).
    13. Kiplagat, Isabella & Mugo, Mercy & Oleche, Martine O., 2021. "Provider Process Quality of Healthcare and its Determinants in Kenya," African Journal of Economic Review, African Journal of Economic Review, vol. 9(4), September.
    14. Guanfu Fang & Hui Cao, 2020. "State versus private provision: How does China’s market‐oriented reform affect healthcare delivery?," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 28(3), pages 381-411, July.

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