Health Services and Policy Research Group, Institute for Health Sciences in Aragón, IACS, Aragon, Spain; REDISSEC-Research Network for Health Services on Chronic Patients, Avda. San Juan Bosco 13 (CIBA Building), 50009, Zaragoza, Spain.
Department of Management, School of Engineering and Architecture, University of Zaragoza, Aragon, Spain.
Health Policy. 2019 Apr;123(4):412-418. doi: 10.1016/j.healthpol.2018.11.009. Epub 2018 Nov 27.
Recently, the once archetype of the public private partnership (PPP) in the Spanish National Health System (SNHS), namely the Alzira's Model, has come to an end. Advocates defended the superiority of PPPs over public-tenured provision, in terms of quality and technical efficiency. This paper profiles and compares Alzira's life-cycle performance with similar public-tenured providers.
Observational study on secondary data from virtually all hospital care episodes produced in 51 integrated providers (i.e., administrative healthcare areas) and 67 hospitals, in 2003 and 2015. Alzira's 2015 performance (and its variation since 2003) was compared with all public-tenured peers in the SNHS, using 26 indicators analysing the differences in age-sex standardized rates of events or risk-adjusted mortality, severity-adjusted hospital expenditure and hospital technical efficiency.
In comparison with the corresponding public-tenured peers, Alzira's 2015 performance was statistically worse than the benchmark in the majority of indicators (15 out of 26); yet, its performance was one of the best in the SNHS in adjusted-mortality after Percutaneous Coronary Intervention (PCI). Over time, Alzira showed a statistically greater 2003-2015 improvement than its peers' average in eleven of the indicators, and a lower improvement in nine.
In this comprehensive comparative study on Alzira's performance, this PPP has not generally outperformed public-tenured providers, although in some areas of care its developments have been outstanding.
最近，西班牙国家卫生系统（SNHS）中公私合作伙伴关系（PPP）的典范——阿尔齐拉模式已经结束。支持者认为，PPP 在质量和技术效率方面优于公共任期供应。本文介绍并比较了阿尔齐拉的全生命周期绩效与类似的公共任期供应商。
对虚拟来自 2003 年和 2015 年 51 个综合提供者（即行政医疗保健区）和 67 家医院的几乎所有医院护理病例的次要数据进行观察性研究。使用 26 个指标分析事件或风险调整死亡率、严重程度调整后的住院支出和医院技术效率的年龄性别标准化率差异，比较了阿尔齐拉 2015 年的表现（及其自 2003 年以来的变化）与其在 SNHS 中的所有公共任期同行。
与相应的公共任期同行相比，阿尔齐拉在大多数指标（26 个中的 15 个）中的 2015 年表现均低于基准；然而，在经皮冠状动脉介入治疗（PCI）后，其调整后的死亡率在 SNHS 中表现最佳之一。随着时间的推移，与同行的平均水平相比，阿尔齐拉在 11 个指标中的 2003-2015 年改善具有统计学意义，在 9 个指标中的改善程度较低。
在对阿尔齐拉绩效的全面比较研究中，这种公私合作伙伴关系并未普遍优于公共任期供应商，尽管在一些护理领域，其发展是杰出的。
