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2016, Number 5

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salud publica mex 2016; 58 (5)

Hospital performance in a segmented and unequal health system: Chile 2001-2010

Cid C, Herrera CA, Prieto L
Full text How to cite this article

Language: Spanish
References: 25
Page: 553-560
PDF size: 260.52 Kb.


Key words:

hospitals, public, private, performance, Chile.

ABSTRACT

Objective. To analyze the differences in health outcomes by hospital characteristics, focusing on ownership: public, private not-for-profit (PNFP) and private for-profit (PFP). Materials and methods. We used a discharged patient dataset of Chilean hospitals for the period 2001-2010 with a total of 16 205 314 discharges in 20 public, six PNFP and 15 PFP hospitals. We selected a subsample of two medical conditions: myocardial infarction and stroke. We used probit regression analyses with mortality rates as dependent variable, ownership status as the key explanatory variable, and control variables which included patients’ health status and socioeconomic level, and hospital characteristics. Results. Private hospitals showed lower risk of death relative to public hospitals: 1.3% in PNFP, 0.7% in PFP and 3.5% in public hospitals. Conclusions. The analysis shows the inequities that exist between public hospitals and the private sector.


REFERENCES

  1. Sloan FA. Not-for-profit ownership and hospital behavior. Handbook Health Econ 2000;1:1141-1174. http://doi.org/cht462

  2. Lagomarsino G, de Ferranti D, Pablos-Mendez A, Nachuk S, Nishtar S, Wibulpolprasert S. Public stewardship of mixed health systems. Lancet 2009;374(9701):1577-1578. http://doi.org/c3t78c

  3. Saltman RB, Ferroussier-Davis O. The concept of stewardship in health policy. Bull World Health Organ 2000;78(6):732-739.

  4. Gray BH, McNerney WJ. For-profit enterprise in health care: The Institute of Medicine Study. N Engl J Med 1986; 314(23):1523-1528. http:// doi.org/bw3wkk

  5. Japsen B. Entrepreneur’s dream. Healthcare venture capital funding keeps record pace. Mod Healthc 1998;28(10):40.

  6. Donovan J. A question of community: at not-for-profit hospitals health is a local affair. Fund Raising Manage1997;28(8):32-35, 42.

  7. Lawrence D. Why we want to remain a nonprofit health care organization. Health Affairs 1997;16(2):118. http://doi.org/bchq2f

  8. Shen Y-C, Eggleston K, Lau J, Schmid CH. Hospital ownership and financial performance: what explains the different findings in the empirical literature? Inquiry 2007;44(1):41-68. http://doi.org/fqnbjp

  9. Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative performance of private and public healthcare systems in low-and middle-income countries: a systematic review. PLoS med 2012;9(6):e1001244. http://doi. org/bnhm

  10. Berendes S, Heywood P, Oliver S, Garner P. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Med 2011;8(4):e1000433. http://doi. org/b8j4wt

  11. Devereaux PJ, Choi PT, Lacchetti C, Weaver B, Schünemann HJ, Haines T, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ 2002;166(11):1399-1406.

  12. Montagu D, Anglemyer A, Tiwari M, Drasser K, Rutherford GW, Horvath TH, et al. Private versus public strategies for health service provision for improving health outcomes in resource limited settings: a systematic review. San Francisco, CA: Global Health Sciences, University of California, San Francisco, 2011.

  13. Devereaux PJ, Heels-Ansdell D, Lacchetti C, Haines T, Burns KE, Cook DJ, et al. Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis. CMAJ 2004;170(12):1817-1824. http://doi.org/bswgm2

  14. Becerril-Montekio V, Reyes JdD, Manuel A. The health system of Chile. Salud Publica Mex 2011;53:s132-s142. http://dx.doi.org/10.1590/S0036- 36342011000800009

  15. Fonasa. Series Estadísticas-Demografía [documento de internet]. Chile: Fondo Nacional de Salud, 2013 [consultado el 15 de abril de 2014]. Disponible en: https://www.fonasa.cl/sites/fonasa/institucional/archivos

  16. Cid-Pedraza C. Diagnoses-based risk adjusted capitation payments for improving solidarity and efficiency in the Chilean health care system: evaluation and comparison with a demographic model (tesis). Essen, Alemania: Universität Duisburg-Essen, 2011.

  17. Cid-Pedraza CC. Problemas y desafíos del seguro de salud y su financiamiento en Chile: el cuestionamiento a las Isapre y la solución funcional. Santiago: Pontificia Universidad Católica de Chile, Vicerrectoría de Comunicaciones y Asuntos Públicos, 2011.

  18. Dipres. Balance de Gestión Integral 2013-FONASA. Santiago: Ministerio de Hacienda, Dirección de Presupuestos, 2014.

  19. Ash AS, Fienberg SF, Louis TA, Normand S-LT, Stukel TA, Utts J. Statistical issues in assessing hospital performance. Baltimore: Centers for Medicare & Medicaid Services, 2012.

  20. Lien H-M, Chou S-Y, Liu J-T. Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan. J Health Econ 2008;27(5):1208-1223. http://doi.org/bzw932

  21. Murray C, Frenk J. World Health Report 2000: a step towards evidence-based health policy. Lancet 2001;357(9269):1698-1700. http:// doi.org/cr93kw

  22. Cid C, Debrott D, Vera M, Hernández L. Hacia un presupuesto poblacional que reemplace el presupuesto histórico en el sistema nacional de servicios de salud: Propuesta metodológica y estimaciones 2009-2010. Santiago: Comisión Sectorial - Mecanismos de Presupuestación y Transferencias, 2009.

  23. Ministerio de Desarrollo Social. Encuesta de Caracterización Socioeconómica Nacional [documento en internet]. Chile: Ministerio de Desarrollo Social, 2006 [consultado en junio de 2014]. Disponible en: http://observatorio.ministeriodesarrollosocial.gob.cl/casen/casen_obj.php.

  24. Minsal. Base de datos Egresos Hospitalarios [Base en Internet] Chile: Ministerio de Salud de Chile 2001-2010 [consultado el 23 de noviembre de 2013]. Disponible en: http://deis.minsal.CL/BDPublica/BD_Egresos.aspx

  25. Sloan FA, Trogdon JG, Curtis LH, Schulman KA. Does the ownership of the admitting hospital make a difference?: Outcomes and process of care of medicare beneficiaries admitted with acute myocardial infarction. Med Care 2003;41(10):1193-1205. http://doi.org/c8hxjj




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