Abstract
There is growing evidence of a positive association between health care providers’ financial standing and the quality of care. In Poland, the instable financial situation and growing debt of public hospitals has been a source of concern for more than two decades now. The objectives of this paper were to compare the financial performance of public hospitals in Poland, depending on the ownership and organizational form; and analyze whether there is an association between financial performance and the chosen variables. We conducted a cross sectional study covering the whole population of public hospitals operating in 2018. The total number of included units was 805. The hospitals’ financial outcomes were measured by several variables; Spearman’s rank correlation was calculated, and a multivariable logistic regression model was performed. In 2018, the majority of public hospitals in Poland (52%) generated a gross loss, while 40% hospitals had overdue liabilities. There were statistically significant differences between hospital groups, with university hospitals and those owned by counties (local hospitals) being in the most disadvantageous situation. Additionally, corporatized public hospitals performed worse than those functioning in the classic legal form of independent health care units. Urgent actions are needed to measure and monitor the potential impact of financial performance on the quality of care.
Highlights
There is growing evidence on the positive association between the health care providers’ financial standing and the quality of care [1,2,3,4,5,6]
If applying the value of total assets and/or revenues as a proxy measure of the hospital size, the data confirm that county hospitals are usually small hospitals; those owned by voivodeship are of medium size; while university clinics include the biggest units
Post hoc pairs comparison indicated statistically significant differences inter alia between (1). Ministerial hospitals and those owned by counties (p < 0.001) and voivodeships (p < 0.001) in terms of the gross profit margin median value; (2) voivodeship hospitals and those owned by counties (p > 0.001); medical universities (p < 0.05) and ministries (p < 0.05) in terms of the debt ratio; (3) county hospitals and those owned by voivodeships (p < 0.05) and medical universities (p < 0.05) in terms of the share of arrears in total liabilities (Table 3)
Summary
There is growing evidence on the positive association between the health care providers’ financial standing and the quality of care [1,2,3,4,5,6]. Stable hospitals are better able to maintain reliable systems and provide resources for quality improvement [1]. In Europe, hospitals constitute the cornerstone of health care provision and are financed mainly from public sources [9]. In 2017, services provided by hospitals consumed more than 35% of total current health expenditures in 24 European countries (out of the 33 for which data are available); the share of public financing in total hospital expenditures was more than 80% in 26 countries and publicly owned hospital beds constituted more than 60% of all hospital beds in 22 countries (out of the 31 for which data are available) [10]. Within the last three decades, implementation of diverse hospital care cost-containment mechanisms has been a common trend of European health systems [9,11]
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