Abstract
BackgroundThe literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care.MethodsWe analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes.ResultsCompared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix.ConclusionsIn combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of hospital ownership type.
Highlights
The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies
The relatively extensive literature comparing the performance of private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from hospitals in high-income and established market economies [3,4,5,6]
We further study the association between hospital ownership type and available measures of hospital structural and outcomes quality for the sub-sample of general-acute hospitals using the following multi-variate regression model: Y 1N 2F X
Summary
The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care. The relatively extensive literature comparing the performance of private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from hospitals in high-income and established market economies [3,4,5,6]. Evidence specific to the quality of care provided in public versus private hospitals remains limited
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