Abstract
Objectives: To qualitatively compare the influence of different ownership which is considered as a kind of institutional environment in public hospitals, private hospitals, and mixed-ownership hospitals on hospital governance structure and organizational behavior. Design: Qualitative descriptive study, using semi-structured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. Participants: 27 key informants including national policymakers in charge of the health sector, influential researchers, local administrators responsible for implementing policies, and hospital managers who are experienced in institutional change. Results: Hospital ownership has a significant influence on hospitals in terms of decision-making power allocation, residual ownership allocation, market entry level, accountability, and social functions. These five aspects in hospital organizational structure incentivize hospitals to adapt to the internal and external environment of the hospital organization—such as market environment, governance, and financing arrangements—affect the behavior of the hospital organization, and ultimately affect the efficiency of hospital operation and quality of service. The incentives under the public system are relatively distorted. Private hospitals have poor performance in failing their social functions due to their insufficient development ability. Compared to them, mixed ownership hospitals have a better performance in terms of incentive mechanism and organizational development. Conclusion: Public hospitals should improve the governance environment and decision-making structure, so as to balance their implementation of social functions and achieve favorable organizational development. For private hospitals, in addition to the optimization of the policy environment, attempts should be made to strengthen their supervision. The development of mixed-ownership hospitals should be oriented towards socialized governance.
Highlights
The public sector in industrialized countries and in developing countries went through a series of transformations [1,2,3,4,5], against the backdrop of the reform of ‘new public management’ or ‘marketization’
It shows that hospital ownership has significant effects on decision-making authority, residual claims, market entry level, accountability, and social functions, and the five aspects in hospital organizational structure represent the key incentives in hospital reform, which together with the external environment faced by hospital organizations—such as market environment, governance, and financing arrangements—affect the behavior of hospital organizations and may influence the efficiency and quality of service
Compared with other studies focusing on hospital ownership with regard to research and efficiency [38], the comparison of quality [39], or the analysis of the performance of some social functions [40], this study mainly describes the organizational structural adjustments and behavioral changes of hospitals of different ownership structures in the face of the environment of property rights
Summary
The public sector in industrialized countries (during the 1960s and 1970s) and in developing countries (during the 1980s) went through a series of transformations [1,2,3,4,5], against the backdrop of the reform of ‘new public management’ or ‘marketization’. These transformations included increasing the management autonomy of the organization, transforming the hierarchical bureaucracy into parastatal corporations that are exposed to competition pressures, and complete detachment from the public sector. Public hospitals experienced autonomization, and many became corporations, aiming at efficiency, equity, and quality improvements. Public Health 2019, 16, 1460; doi:10.3390/ijerph16081460 www.mdpi.com/journal/ijerph
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