Department of Management, Catholic University, Rome, Italy.
Value Health. 2013 Jan-Feb;16(1 Suppl):S24-33. doi: 10.1016/j.jval.2012.10.003. Epub 2012 Nov 15.
Many countries with universal health systems have relied primarily on publicly-owned hospitals to provide acute care services to covered populations; however, many policymakers have experimented with expansion of the private sector for what they hope will yield more cost-effective care. The study provides new insight into the effects of hospital privatization in three American states (California, Florida, and Massachusetts) in the period 1994 to 2003, focusing on three aspects: 1) profitability; 2) productivity and efficiency; and 3) benefits to the community (particularly, scope of services offered, price level, and impact on charity care). For each variable analyzed, we compared the 3-year mean values pre- and postconversion. Pre- and postconversion changes in hospitals' performance were then compared with a nonequivalent comparison group of American public hospitals. The results of our study indicate that following privatization, hospitals increased operating margins, reduced their length of stay, and enjoyed higher occupancy, but at some possible cost to access to care for their communities in terms of higher price markups and loss of beneficial but unprofitable services.
许多实行全民医保的国家主要依靠公立医疗机构为参保人群提供急症护理服务；然而，许多决策者已尝试扩大私营部门，希望以此提高成本效益。本研究提供了有关美国加利福尼亚州、佛罗里达州和马萨诸塞州三个州在 1994 年至 2003 年期间医院私有化影响的新见解，重点关注三个方面：1）盈利性；2）生产力和效率；以及 3）对社区的益处（特别是提供的服务范围、价格水平以及对慈善医疗的影响）。我们对每个分析变量进行了比较，比较了转换前后三年的平均值。然后，将医院绩效的转化前后变化与美国公立医院的非等效比较组进行了比较。我们的研究结果表明，私有化后，医院的运营利润率提高了，住院时间缩短了，入住率也提高了，但在一定程度上可能会损害社区获得医疗服务的机会，因为价格标签更高，以及有利但不盈利的服务减少。
