1
|
van der Schors W, Roos AF, Kemp R, Varkevisser M. Reasons for merging and collaborating in healthcare: Marriage or living apart together? Int J Health Plann Manage 2023; 38:1721-1742. [PMID: 37544018 DOI: 10.1002/hpm.3695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 02/01/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Across OECD countries, integration between healthcare organisations has become an indispensable part of contemporary healthcare provision. In recent years, inter-organisational collaboration has increasingly been encouraged in health and competition policy at the expense of mergers. Yet, understanding of whether healthcare organisations make an active choice between merging and collaborating is lacking. Hence, this study systematically examines (i) healthcare executives' motives for integration, (ii) their potential trade-offs between collaborating or merging, and (iii) the barriers to collaborating perceived by them. METHODS Early 2019, an online questionnaire was conducted among a nationwide panel of 714 healthcare executives in the Netherlands. Because of their strategic position within healthcare organisations as end-responsible managers, healthcare executives are especially suited to provide broad and in-depth knowledge on the internal and external processes and decisions. Three hundred thirty-seven Dutch healthcare executives completed the questionnaire (response rate 47%). This study sample was representative of the largest healthcare sectors in the Netherlands. In total, 137 mergers and 235 inter-organisational collaborations were reported. Both closed questions and open-ended questions were systematically analysed. RESULTS Improving or broadening healthcare provision is the foremost motive for mergers as well as inter-organisational collaborations. When considering both types, reducing governance complexity is one of the decisive reasons to opt for a merger, whereas aversion towards a full merger and lack of support base within the own organisation convinced healthcare executives to choose for a collaboration. When comparing specific healthcare sectors, the overlap in pursued motives and sub-motives indicates that inter-organisational collaborations and mergers are used for comparable objectives. Only a small minority of the responding executives switched between both types of integration. Institutional barriers, such as laws, regulations and financing regimes, appear to be the most restricting for healthcare executives to engage in inter-organisational collaborations. CONCLUSIONS Our integral approach and systematic comparison across sectors could serve policymakers, regulators and healthcare providers in aligning organisational objectives and societal objectives in decision-making on collaborations and mergers. Future research is recommended to study multiple collaboration and merger cases qualitatively for a detailed examination of decision-making by healthcare executives, and develop an integral assessment framework for balancing collaborations and mergers based on their effects in the medium to long term.
Collapse
Affiliation(s)
- Wouter van der Schors
- Erasmus University Rotterdam, Rotterdam, The Netherlands
- Dutch Health and Youth Care Inspectorate, Utrecht, The Netherlands
| | - Anne-Fleur Roos
- Erasmus University Rotterdam, Rotterdam, The Netherlands
- Netherlands Bureau for Economic Policy Analysis, The Hague, The Netherlands
| | - Ron Kemp
- Erasmus University Rotterdam, Rotterdam, The Netherlands
- Netherlands Authority for Consumers and Markets, The Hague, The Netherlands
| | | |
Collapse
|
2
|
Abstract
Ajay Aggarwal and colleagues argue that relying on patient choice to cut waiting times is oversimplistic and likely to widen inequalities
Collapse
Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Richard Sullivan
- Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
3
|
The return of inverse care: Case study of elective hip surgery. Lancet Reg Health Eur 2022; 21:100495. [PMID: 36035629 PMCID: PMC9413945 DOI: 10.1016/j.lanepe.2022.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
4
|
Costa Font J, Levaggi R, Turati G. Resilient managed competition during pandemics: lessons from the Italian experience during COVID-19. HEALTH ECONOMICS, POLICY, AND LAW 2022; 17:212-219. [PMID: 32883395 PMCID: PMC7578624 DOI: 10.1017/s1744133120000353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/02/2020] [Accepted: 08/02/2020] [Indexed: 12/03/2022]
Abstract
In the last decades, several European health systems have abandoned their vertically integrated health care in favour of some form of managed competition (MC), either in a centralised or decentralised format. However, during a pandemic, MC may put health systems under additional strain as they are designed to follow some form of 'organisational self-interest', and hence face reduced incentives for both provider coordination (e.g. temporary hospital close down, change in the case-mix), and information sharing. We illustrate our argument using evidence for the Covid-19 pandemic outbreak in Italy during March and April 2020, which calls for the development of 'coordination mechanisms' at times of a health emergency.
Collapse
Affiliation(s)
- Joan Costa Font
- Department of Health Policy, London School of Economics, London, UK
| | - Rosella Levaggi
- CESIfo and IZA Department of Economics and Management, University of Brescia, Brescia, Italy
| | - Gilberto Turati
- Department of Economics and Finance, Università Cattolica del Sacro Cuore – Rome Campus, Rome, Italy
| |
Collapse
|
5
|
Davies C, Davies S. Assessing competition in the hip implant industry in the light of recent policy guidance. Soc Sci Med 2021; 287:114055. [PMID: 34144844 DOI: 10.1016/j.socscimed.2021.114055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022]
Abstract
NHS procurement is a highly topical area, attracting a great deal of recent policy focus. The pivotal report by Lord Carter of Coles (2016) highlighted unwarranted variation, estimating it to be worth approximately £5bn in efficiency savings. In relation to hip replacement surgery, recent procurement policy guidance has recommended the use of cemented hip implants for all patients aged 68 years and over in England and Wales. Previous work established that the hip implant supplying market was very concentrated, with only a few large suppliers, especially for cemented implants. The advocated major shift towards cemented implants would almost certainly increase further the market share of the dominant manufacturer of cemented sector thus raising potential competition and welfare issues. We carry out a market study to establish whether there might be a potential competition concern, using data from the National Joint Registry (2005-2018, 37 suppliers, nearly 700 models). We first establish the structure of the industry with a specific focus on seller concentration. Secondly we evaluate the dynamics underlying concentration in the market, assessing the innovative performance of the sector using a novel statistical analysis of the dynamics of market shares. We then look to three comparable but alternative markets for similarities or differences to the THR implant industry. We find a high and increasingly concentrated oligopolistic and static market structure, largely devoid of dynamics and with no real sign of innovation. These findings are further emphasized when compared with the three close alternative markets. Although this stability could just be a mature market where technical advances have already taken place, our findings highlight the potential welfare and policy implications of concentrating on cemented fixation. Given the current emphasis on efficiency in procurement, it is essential that there should also be scrutiny of the firms dealing with public procurement.
Collapse
Affiliation(s)
- Charlotte Davies
- Health Economics Group, Norwich Medical School, University of East Anglia, UK.
| | | |
Collapse
|
6
|
van der Schors W, Roos AF, Kemp R, Varkevisser M. Inter-organizational collaboration between healthcare providers. Health Serv Manage Res 2020; 34:36-46. [PMID: 33291978 DOI: 10.1177/0951484820971456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Across OECD countries, healthcare organizations increasingly rely on inter-organizational collaboration (IOC). Yet, systematic insight into the relations across different healthcare sectors is lacking. The aim of this explorative study is twofold. First, to understand how IOC differs across healthcare sectors with regards to characteristics, motives and the role of health policy. Second, to understand which potential effects healthcare executives consider prior to the establishment of the collaborations. For this purpose, a survey was conducted among a representative panel of Dutch healthcare executives from medium-sized or large healthcare organizations. Almost half (n = 344, 48%) of the invited executives participated. Our results suggest that differences in policy changes and institutional developments across healthcare sectors affect the scope and type of IOC: hospitals generally operate in small horizontal collaborations, while larger and more complex mixed and non-horizontal collaborations are more present among nursing homes, disability care and mental care organizations. We find that before establishing IOCs, most healthcare executives conduct a self-assessment including the potential effects of the collaboration. The extensive overview of policy developments, collaboration types and intended outcomes presented in our study offers a useful starting point for a more in-depth assessment of the effectiveness of collaborations among healthcare organizations.
Collapse
Affiliation(s)
- Wouter van der Schors
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Anne-Fleur Roos
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.,CPB Netherlands Bureau of Economic Policy Analysis, Den Haag, the Netherlands
| | - Ron Kemp
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.,Netherlands Authority for Consumer and Markets (ACM), Den Haag, the Netherlands
| | - Marco Varkevisser
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| |
Collapse
|
7
|
Alvarado N, McVey L, Greenhalgh J, Dowding D, Mamas M, Gale C, Doherty P, Randell R. Exploring variation in the use of feedback from national clinical audits: a realist investigation. BMC Health Serv Res 2020; 20:859. [PMID: 32917202 PMCID: PMC7488667 DOI: 10.1186/s12913-020-05661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022] Open
Abstract
Background National Clinical Audits (NCAs) are a well-established quality improvement strategy used in healthcare settings. Significant resources, including clinicians’ time, are invested in participating in NCAs, yet there is variation in the extent to which the resulting feedback stimulates quality improvement. The aim of this study was to explore the reasons behind this variation. Methods We used realist evaluation to interrogate how context shapes the mechanisms through which NCAs work (or not) to stimulate quality improvement. Fifty-four interviews were conducted with doctors, nurses, audit clerks and other staff working with NCAs across five healthcare providers in England. In line with realist principles we scrutinised the data to identify how and why providers responded to NCA feedback (mechanisms), the circumstances that supported or constrained provider responses (context), and what happened as a result of the interactions between mechanisms and context (outcomes). We summarised our findings as Context+Mechanism = Outcome configurations. Results We identified five mechanisms that explained provider interactions with NCA feedback: reputation, professionalism, competition, incentives, and professional development. Professionalism and incentives underpinned most frequent interaction with feedback, providing opportunities to stimulate quality improvement. Feedback was used routinely in these ways where it was generated from data stored in local databases before upload to NCA suppliers. Local databases enabled staff to access data easily, customise feedback and, importantly, the data were trusted as accurate, due to the skills and experience of staff supporting audit participation. Feedback produced by NCA suppliers, which included national comparator data, was used in a more limited capacity across providers. Challenges accessing supplier data in a timely way and concerns about the quality of data submitted across providers were reported to constrain use of this mode of feedback. Conclusion The findings suggest that there are a number of mechanisms that underpin healthcare providers’ interactions with NCA feedback. However, there is variation in the mode, frequency and impact of these interactions. Feedback was used most routinely, providing opportunities to stimulate quality improvement, within clinical services resourced to collect accurate data and to maintain local databases from which feedback could be customised for the needs of the service.
Collapse
Affiliation(s)
- Natasha Alvarado
- School of Healthcare and the Wolfson Centre for Applied Health Research, University of Leeds, Leeds, England.
| | - Lynn McVey
- School of Healthcare and the Wolfson Centre for Applied Health Research, University of Leeds, Leeds, England
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, England
| | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, England
| | - Mamas Mamas
- Primary Care and Health Sciences, Keele University, Keele, England
| | | | - Patrick Doherty
- Department of Health Sciences, York University, York, England
| | - Rebecca Randell
- Faculty of Health Studies and the Wolfson Centre for Applied Health Research University of Bradford, Bradford, England
| |
Collapse
|
8
|
Lin X, Jian W, Yip W, Pan J. Perceived Competition and Process of Care in Rural China. Risk Manag Healthc Policy 2020; 13:1161-1173. [PMID: 32884377 PMCID: PMC7439494 DOI: 10.2147/rmhp.s258812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Although there is much debate about the effect of hospital competition on healthcare quality, its impact on the process of care remains unclear. This study aimed to determine whether hospital competition improves the process of care in rural China. Patients and Methods The county hospital questionnaire survey data and the randomly sampled medical records of bacterial pneumonia patients in 2015 in rural area of Guizhou, China, were used in this study. The processes of care for bacterial pneumonia were measured by the following three measures: 1) oxygenation assessment, 2) antibiotic treatment, and 3) first antibiotic treatment within 6 hours after admission. Hospital competition was measured by asking hospital directors to rate the competition pressure they perceive from other hospitals. Multivariate logistic regression models were employed to determine the relationship between perceived competition and the processes of care for patients with bacterial pneumonia. Results A total of 2167 bacterial pneumonia patients from 24 county hospitals in 2015 were included in our study. Our results suggested that the likelihood of receiving antibiotic treatment and first antibiotic treatment within 6 hours after admission was significantly higher in the hospitals perceiving higher competition pressure. However, no significant relationship was found between perceived competition and oxygenation assessment for patients with bacterial pneumonia. Conclusion This study revealed the role of perceived competition in improving the process of care under the fee-for-service payment system and provided empirical evidence to support the pro-competition policies in China’s new round of national healthcare reform.
Collapse
Affiliation(s)
- Xiaojun Lin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China.,West China Research Center for Rural Health Development, Sichuan University, Chengdu, People's Republic of China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China
| | - Winnie Yip
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China.,West China Research Center for Rural Health Development, Sichuan University, Chengdu, People's Republic of China
| |
Collapse
|
9
|
Levaggi L, Levaggi R. Is there scope for mixed markets in the provision of hospital care? Soc Sci Med 2020; 247:112810. [PMID: 31986453 DOI: 10.1016/j.socscimed.2020.112810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/09/2020] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
Market oriented reforms in hospital care have produced a variety of quasi markets that differ for the type of providers that are allowed to compete. Mixed markets, where public hospitals compete alongside private ones, are increasingly common, but the literature does not agree on their performances and their desirability. We review the contributions in this field by proposing a common framework which allows to account for the different approaches proposed to model public hospitals. In this paper we show under which conditions mixed markets perform better in terms of average quality, and we review the empirical literature to determine whether these conditions are met. In general, pure forms (private or public competition) are superior to mixed markets, unless patients interpret public hospitals as reference suppliers, and quality of care is important. The empirical evidence on these key questions shows that public hospitals behave differently from private organisations, but they are not necessarily less efficient. Research into patients choices seems to suggest that ownership is a value, but the empirical literature is still rather scant. From a policy point of view, our review suggests that there does not seem to be a clear answer to whether this market form should be used. Local conditions are going to play an important role.
Collapse
Affiliation(s)
- Laura Levaggi
- Faculty of Science and Technology, Free University of Bolzano, Piazza Università 5, Bolzano, Italy.
| | - Rosella Levaggi
- Department of Economics and Management, University of Brescia, Italy.
| |
Collapse
|
10
|
Avdic D, Moscelli G, Pilny A, Sriubaite I. Subjective and objective quality and choice of hospital: Evidence from maternal care services in Germany. JOURNAL OF HEALTH ECONOMICS 2019; 68:102229. [PMID: 31521024 DOI: 10.1016/j.jhealeco.2019.102229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 05/25/2023]
Abstract
We study patient choice of healthcare provider based on both objective and subjective quality measures in the context of maternal care hospital services in Germany. Objective measures are obtained from publicly reported clinical indicators, while subjective measures are based on satisfaction scores from a large and nationwide patient survey. We merge both quality metrics to detailed hospital discharge records and quantify the additional distance expectant mothers are willing to travel to give birth in maternity clinics with higher reported quality. Our results reveal that patients are on average willing to travel 0.1-2.7 additional kilometers for a one standard deviation increase in quality. Patients respond to both objective and subjective quality measures, suggesting that patient satisfaction scores may constitute important complements to clinical indicators when choosing provider.
Collapse
Affiliation(s)
- Daniel Avdic
- Centre for Health Economics, Monash Business School, Monash University Level 5, Building H, Caulfield Campus, 900 Dandenong Road, Caulfield East, VIC 3145, Australia.
| | | | - Adam Pilny
- RWI - Leibniz-Institut für Wirtschaftsforschung, Germany
| | | |
Collapse
|
11
|
Dissolution of Canada's Single-Tiered Health System Would Threaten the Health of Women with Disabilities. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1616-1618. [PMID: 31521540 DOI: 10.1016/j.jogc.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 11/21/2022]
Abstract
Dissolution of Canada's single-tiered health system is now before the Supreme Court of British Columbia and will soon be before the Supreme Court of Canada. If our Supreme Court justices are persuaded to dissolve the Canada Health Act, financially advantaged Canadians will be permitted to purchase privileged access to physicians, diagnostic tests, and surgical facilities. This queue jumping will diminish access for the socioeconomically disadvantaged, among whom women are overrepresented, including women living with disabilities, women of Indigenous heritage, and women who have recently immigrated to Canada. For example, women with disabilities receive fewer Pap tests and mammograms, as do women of First Nations communities, who are also reported to have a higher incidence of cervical cancer deaths. The option for physicians to "opt out" of public care is particularly problematic in Canada because we have one of the lowest physician-to-patient ratios of "developed" countries. Social justice in health promotion in Canada is threatened by those who would dissolve the Canada Health Act in neoliberal-thinking ink because social justice can flourish only when the prevailing imperatives in our health system are equality and not wallet size, access and not gatekeeping, fairness and not finance. Social justice in health promotion insists on improving the social determinants of health of all Canadians, not just financially better-off Canadians who already have access to better health outcomes through better nutrition, better environments, and better access to health professionals.
Collapse
|