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Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering

Published online by Cambridge University Press:  06 April 2017

Terje P. Hagen ,
Geir Hiller Holom  and
Kebebew N. Amayu
Terje P. Hagen*
Affiliation:
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
Geir Hiller Holom
Affiliation:
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
Kebebew N. Amayu
Affiliation:
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
*
*Correspondence to: Terje P. Hagen, Department of Health Management and Health Economics, University of Oslo, P.O. Box 1098, 0317 Oslo, Norway. Email: t.p.hagen@medisin.uio.no
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Abstract

Setting prices for elective patient treatments in private for-profit (PFP) hospitals in traditional tax-funded health systems is challenging since both the organisation of these hospitals and the tasks they perform differ considerably from what we find in public hospitals. From the year 2000, Norway became one of a few countries to gradually implement a procurement system based on competitive tendering when outsourcing elective surgery. In this study we analyse the effect of introducing competitive tendering on the prices paid to PFP hospitals. Pricing data were collected from the formal contracts awarded to PFP hospitals and defined in terms of both absolute and relative prices. We found that PFP hospitals performed day surgeries at markedly lower prices than public hospitals and that competitive tendering triggered the price reduction. We speculate that the PFP hospitals’ lack of acute services, less severe patient population, reduced teaching responsibilities and ability to streamline production, as well as other factors, explain the lower prices at PFP hospitals.

Type
Articles
Information
Health Economics, Policy and Law , Volume 13 , Issue 1 , January 2018 , pp. 50 - 67
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Copyright
© Cambridge University Press 2017 

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References

André, C. and Hermann, C. (2008), ‘Privatisation of health care in Europe’, CNRS/FORBA (Working Life Research Centre), Paris/Vienna.Google Scholar
Ashton, T. (1998), ‘Contracting for health services in New Zealand: a transaction cost analysis’, Social Science & Medicine, 46(3): 357–367.Google Scholar
Ashton, T. (2010), ‘The benefits and risks of DHBs contracting out elective procedures to private providers’, The New Zealand Medical Journal, 123(1314): 84–91.Google Scholar
Askildsen, J. E. and Holmås, T. H. (2013), ‘Wages and work conditions as determinants for physicians’ work decisions’, Applied Economics, 45(3): 397–406.CrossRefGoogle Scholar
Augurzky, B. and Scheuer, M. (2007), ‘Outsourcing in the German hospital sector’, The Service Industries Journal, 27(3): 263–277.Google Scholar
Barros, P. P. and Monteiro, R. S. (2016), ‘Public-Private Partnerships’, in Richard M. Scheffler (ed.), World Scientific Handbook of Global Health Economics and Public Policy, Hackensack, NJ: World Scientific Publishing Co. Pte Ltd, 351–404.Google Scholar
Bisman, J. E. (2008), ‘Australian public‐sector outsourcing in the ‘golden era’: cost savings evidence or anecdote?’, Australian Accounting Review, 18(2): 108–122.Google Scholar
Chard, J., Kuczawski, M., Black, N. and van der Meulen, J. (2011), ‘Outcomes of elective surgery undertaken in independent sector treatment centres and NHS providers in England: audit of patient outcomes in surgery’, BMJ, 343: d6404.Google Scholar
Dijkgraaf, E. and Gradus, R. (2007), ‘Fair competition in the refuse collection market?’, Applied Economics Letters, 14(10): 701–704.Google Scholar
Domberger, S. and Jensen, P. (1997), ‘Contracting out by the public sector: theory, evidence, prospects’, Oxford Review of Economic Policy, 13(4): 67–78.Google Scholar
Elinder, M. and Jordahl, H. (2013), ‘Political preferences and public sector outsourcing’, European Journal of Political Economy, 30: 43–57.Google Scholar
Ellis, R. P. (1998), ‘Creaming, skimping and dumping: provider competition on the intensive and extensive margins’, Journal of Health Economics, 17(5): 537–555.CrossRefGoogle ScholarPubMed
Gawande, A. A., Zinner, M. J., Studdert, D. M. and Brennan, T. A. (2003), ‘Analysis of errors reported by surgeons at three teaching hospitals’, Surgery, 133(6): 614–621.Google Scholar
Guimarães, C. M. and de Carvalho, J. C. (2011), ‘Outsourcing in the healthcare sector-a state-of-the-art review’, Supply Chain Forum: An International Journal, 12 (2): 140–148.CrossRefGoogle Scholar
Hagen, T. P. and Kaarbøe, O. M. (2006), ‘The Norwegian hospital reform of 2002: central government takes over ownership of public hospitals’, Health Policy, 76(3): 320–333.Google Scholar
Hencher, D. A. and Wallis, I. P. (2005), ‘Competitive tendering as a contracting mechanism for subsidising transport’, Journal of Transport Economics and Policy, 39(3): 295–321.Google Scholar
Ho, V. and Aloia, T. (2008), ‘Hospital volume, surgeon volume, and patient costs for cancer surgery’, Medical Care, 46(7): 718–725.Google Scholar
Hofer, S. and Rohrer, M. (2011), ‘Outsourcing of facility services in Swiss hospitals’, Institute of Facility Management, Zurich.Google Scholar
Jensen, P. H. and Stonecash, R. E. (2005), ‘Incentives and the efficiency of public sector‐outsourcing contracts’, Journal of Economic Surveys, 19(5): 767–787.Google Scholar
Johannessen, K. A. and Hagen, T. P. (2013), ‘Individual and hospital-specific factors influencing medical graduates’ time to medical specialization’, Social Science & Medicine, 97: 170–175.Google Scholar
Kjekshus, L. E. and Hagen, T. P. (2005), ‘Ring fencing of elective surgery: does it affect hospital efficiency?’, Health Services Management Research, 18(3): 186–197.CrossRefGoogle ScholarPubMed
Kobel, C., Thuilliez, J., Bellanger, M. and Pfeiffer, K.-P. (2011), ‘DRG Systems and Similar Patient Classification Systems in Europe’. In R. Busse, A. Geissler, W. Quentin and M. Wiley (eds): Diagnosis-Related Groups in Europe: Moving Towards Transparency, Efficiency and Quality in Hospitals, 1st edn. Buckingham: Open University Press and WHO Regional Office for Europe, 37–58.Google Scholar
Laffont, J. J. and Tirole, J. (1988), ‘The dynamics of incentive contracts’, Econometrica, 56(5): 1153–1175.CrossRefGoogle Scholar
Laffont, J. J. and Tirole, J. (1990), ‘Adverse selection and renegotiation in procurement’, Review of Economic Studies, 57(4): 597–625.Google Scholar
Laffont, J.-J. and Tirole, J. (1993), A Theory of Incentives in Procurement and Regulation, Cambridge, MA: MIT Press.Google Scholar
Lopez-Casasnovas, G. and Saez, M. (1999), ‘The impact of teaching status on average costs in Spanish hospitals’, Health Economics, 8(7): 641–651.Google Scholar
Macinati, M. S. (2008), ‘Outsourcing in the Italian National Health Service: findings from a national survey’, The International Journal of Health Planning and Management, 23(1): 21–36.CrossRefGoogle ScholarPubMed
Magnussen, J., Vrangbæk, K., Saltman, R. B. and Martinussen, P. E. (2009), ‘Introduction: The Nordic Model of Health Care’, in J. Magnussen, K. Vrangbaek and R. B. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Changes, Maidenhead: Open University Press, 1–34.Google Scholar
Mason, A., Street, A. and Verzulli, R. (2010), ‘Private sector treatment centres are treating less complex patients than the NHS’, Journal of the Royal Society of Medicine, 103(8): 322–331.Google Scholar
Mason, A., Street, A., Miraldo, M. and Siciliani, L. (2009), ‘Should prospective payments be differentiated for public and private healthcare providers?’, Health Economics Policy and Law, 4(4): 383–403.CrossRefGoogle ScholarPubMed
Milne, R. G. and Wright, R. E. (2004), ‘Competition and costs: evidence from competitive tendering in the Scottish National Health Service’, Scottish Journal of Political Economy, 51(1): 1–23.Google Scholar
Petersen, O. H., Hjelmar, U., Vrangbæk, K. and la Cour, L. (2012), ‘Effects of contracting out public sector tasks A research-based review of Danish and international studies from 2000-2011’. Copenhagen: Amtkommunernes og kommunernes forskningsstiftelse (AKF) AKF.Google Scholar
Posnett, J. (1999), ‘The hospital of the future: is bigger better? Concentration in the provision of secondary care’, BMJ, 319(7216): 1063.Google Scholar
Ringard, Å., Sagan, A., Sperre Saunes, I. and Lindahl, A. K. (2013), ‘Norway: health system review’, Health Systems in Transition, 15(8): 1–162.Google Scholar
Rogne, K. (2007), ‘Lower costs or increased selection?: effects of privatization of day surgery treatments in Norway’, Thesis, Department of Health Management and Health Economics, University of Oslo.Google Scholar
Sclar, E. D. (2001), You Don’t Always Get What You Pay For: The Economics of Privatization, Itacha, NY: Cornell University Press.Google Scholar
Siciliani, L. and Hurst, J. (2005), ‘Tackling excessive waiting times for surgery: a comparative analysis of policies in 12 OECD countries’, Health Policy, 72(2): 201–215.Google Scholar
Singh, H., Thomas, E. J., Petersen, L. A. and Studdert, D. M. (2007), ‘Medical errors involving trainees: a study of closed malpractice claims from 5 insurers’, Archives of Internal Medicine, 167(19): 2030–2036.Google Scholar
Soliño, A. S. and Gago de Santos, P. (2010), ‘Transaction costs in transport public–private partnerships: comparing procurement procedures’, Transport Reviews, 30(3): 389–406.Google Scholar
Soliño, A. S. and Gago de Santos, P. (2016), ‘Influence of the tendering mechanism in the performance of public-private partnerships: a transaction cost approach’, Public Performance & Management Review, 40(1): 1–23.Google Scholar
Street, A., Sivey, P., Mason, A., Miraldo, M. and Siciliani, L. (2010), ‘Are English treatment centres treating less complex patients?’, Health Policy, 94(2): 150–157.CrossRefGoogle ScholarPubMed
Vrangbaek, K. and Ostergren, K. (2006), ‘Patient empowerment and the introduction of hospital choice in Denmark and Norway’, Health Economics, Policy and Law, 1(Pt 4): 371–394.Google Scholar
Vrangbaek, K., Robertson, R., Winblad, U., Van de Bovenkamp, H. and Dixon, A. (2012), ‘Choice policies in Northern European health systems’, Health Economics, Policy and Law, 7(1): 47–71.Google Scholar
Weeks, W. B., Jardin, M. and Paraponaris, A. (2015), ‘Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010’, Social Science & Medicine, 133: 53–58.Google Scholar
Young, S. (2007), ‘Outsourcing: uncovering the complexity of the decision’, International Public Management Journal, 10(3): 307–325.CrossRefGoogle Scholar