Analysis of the technical efficiency of the forms of hospital management based on public‐private collaboration of the Madrid Health Service, as compared with traditional management

Abstract

Fundamentos: Realizar un análisis comparativo de la eficiencia técnica de la gestión hospitalaria basada en la colaboración público-privada, respecto a la gestión tradicional. En concreto, se comparan hospitales públicos de gestión tradicional, hospitales públicos gestionados mediante Private Finance Initiative (PFI), hospitales públicos gestionados mediante Public Private Partnership (PPP) y hospitales gestionados mediante otras formas de gestión, durante el periodo 2009-2014, en los hospitales dependientes del Servicio Madrileño de Salud (SERMAS).

Métodos: El estudio abarca la totalidad de la población de hospitales generales de titularidad pública dependientes del SERMAS, formada por 7 hospitales PFI, 3 hospitales PPP, 11 hospitales públicos de gestión tradicional (con la categoría de hospital general) y 4 hospitales gestionados mediante otras formas de gestión. Se calcularon los índices de eficiencia técnica de los hospitales utilizando la técnica del análisis envolvente de datos (AED). Posteriormente, se realizó un análisis de sensibilidad mediante bootstrapping y variación de variables del modelo, para verificar su impacto en la eficiencia. Finalmente, se realizó un análisis de evolución de la eficiencia en el periodo analizado mediante el Índice de Malmquist (IM).

Resultados: en todos los modelos de análisis efectuados en el periodo analizado, los hospitales gestionados mediante las formas de gestión basadas en colaboración público-privada fueron más eficientes que los hospitales de gestión tradicional.

Conclusiones: la mayor eficiencia de los hospitales gestionados siguiendo formas de gestión basadas en la colaboración público-privada, respecto a los de gestión tradicional, podría atribuirse a la mayor flexibilidad organizativa y de gestión.Fundamentals: the study aims to carry out a comparative analysis of the technical efficiency of hospital management based on public‐private collaboration, as compared with traditional management. Specifically, we compare traditionally managed public hospitals, public hospitals managed by a private finance initiative (PFI), public hospitals managed through a public‐private partnership (PPP), and hospitals managed through other forms of management, during the period 2009 to 2014, in the hospitals dependent on the Madrid Health Service (SERMAS).

Methods: the study covers all publicly owned general hospitals under SERMAS, consisting of seven PFI hospitals, three PPP hospitals, 11 traditionally managed public hospitals (with the category of general hospital), and four hospitals managed through other forms of hospital management. The technical efficiency indices of the hospitals were calculated using the data envelopment analysis technique. Subsequently, a sensitivity analysis was performed by bootstrapping and variation of model variables to verify their impact on efficiency. Finally, an analysis of the evolution of efficiency in the analyzed period was carried out using the Malmquist Index.

Results: in all the analysis models carried out in the analyzed period, the hospitals managed based on public‐private collaboration were more efficient than the hospitals under traditional management.

Conclusions: the greater efficiency of hospitals managed based on public‐private collaboration, as compared with traditional management, could be attributed to greater organizational and management flexibility. https://onlinelibrary.wiley.com/doi/abs/10.1002/hpm.2678