¿Gestión pública, privada o por el tercer sector? Diferencias en los resultados en atención primaria de Cataluña

Abstract

GoalCompare the performance of primary health centers managed by the public sector (ICS), the third sector (Hospitals) or by small private organizations known as EBAs. DesignMultidimensional comparative analysis. We follow a quasi-experimental logic comparing primary health centers managed by EBAs with other centers managed by the public sector (ICS) o by the third sector (hospitals). LocalizationBarcelona, Catalonia, Spain. ParticipantsWe have 368 observations (primary health centers) and 18 indicators measured in 2015. InterventionDifferent management models (public, third sector, private). Main measuresWe compare activity measures, measures of effectiveness in the process of medical assistance, and efficiency. We compare before and after controlling for the socio-economic level corresponding to the basic health area and the characteristics of the population and health region. We conduct a test of significant differences between the indicators corresponding to centers managed differently, after a process of matching using key variables and Propensity Score Matching. ResultsSignificant differences in the measure of work load for family doctors, in five measures of effectiveness in the process of assistance and in the cost per user. ConclusionsThe diversity in the management model through EBAs shows results that can be interpreted in favor of the maintenance or the expansion of this model of management. The majority of EBAs have been implanted in areas of a medium or high level, but their results are still significantly positive once the socio economic level of the area is controlled.