IDEAS home Printed from https://ideas.repec.org/p/por/fepwps/577.html
   My bibliography  Save this paper

The Role Of Private Non-Profit Healthcare Organizations In Nhs Systems: Implications For The Portuguese Hospital Devolution Program

Author

Listed:
  • Alvaro S Almeida

    (CEF.UP and Faculdade de Economia, Universidade do Porto)

Abstract

The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality.

Suggested Citation

  • Alvaro S Almeida, 2016. "The Role Of Private Non-Profit Healthcare Organizations In Nhs Systems: Implications For The Portuguese Hospital Devolution Program," FEP Working Papers 577, Universidade do Porto, Faculdade de Economia do Porto.
    • Handle: RePEc:por:fepwps:577
    as

    Download full text from publisher

    File URL: http://www.fep.up.pt/investigacao/workingpapers/wp577.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Tynkkynen, Liina-Kaisa & Chydenius, Miisa & Saloranta, Anna & Keskimäki, Ilmo, 2016. "Expanding choice of primary care in Finland: much debate but little change so far," Health Policy, Elsevier, vol. 120(3), pages 227-234.
    2. Toth, Federico, 2016. "Classification of healthcare systems: Can we go further?," Health Policy, Elsevier, vol. 120(5), pages 535-543.
    3. Cristian A Herrera & Gabriel Rada & Lucy Kuhn-Barrientos & Ximena Barrios, 2014. "Does Ownership Matter? An Overview of Systematic Reviews of the Performance of Private For-Profit, Private Not-For-Profit and Public Healthcare Providers," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-18, December.
    4. Anderson, Stuart, 2012. "Public, private, neither, both? Publicness theory and the analysis of healthcare organisations," Social Science & Medicine, Elsevier, vol. 74(3), pages 313-322.
    5. Sima Berendes & Peter Heywood & Sandy Oliver & Paul Garner, 2011. "Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies," PLOS Medicine, Public Library of Science, vol. 8(4), pages 1-10, April.
    6. Anup Malani & Guy David, 2008. "Does Nonprofit Status Signal Quality?," The Journal of Legal Studies, University of Chicago Press, vol. 37(2), pages 551-576, June.
    7. Turner, Simon & Allen, Pauline & Bartlett, Will & Pérotin, Virginie, 2011. "Innovation and the English National Health Service: A qualitative study of the independent sector treatment centre programme," Social Science & Medicine, Elsevier, vol. 73(4), pages 522-529, August.
    8. Bayindir, Esra Eren, 2012. "Hospital ownership type and treatment choices," Journal of Health Economics, Elsevier, vol. 31(2), pages 359-370.
    9. Susan Rose-Ackerman, 1996. "Altruism, Nonprofits, and Economic Theory," Journal of Economic Literature, American Economic Association, vol. 34(2), pages 701-728, June.
    10. Harrison Teresa D. & Lybecker Kristina M., 2005. "The Effect of the Nonprofit Motive on Hospital Competitive Behavior," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 4(1), pages 1-15, May.
    11. Richard G. Frank & David S. Salkever, 1991. "The Supply of Charity Services by Nonprofit Hospitals: Motives and Market Structure," RAND Journal of Economics, The RAND Corporation, vol. 22(3), pages 430-445, Autumn.
    12. Krachler, Nick & Greer, Ian, 2015. "When does marketisation lead to privatisation? Profit-making in English health services after the 2012 Health and Social Care Act," Social Science & Medicine, Elsevier, vol. 124(C), pages 215-223.
    13. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2013. "Five types of OECD healthcare systems: Empirical results of a deductive classification," Health Policy, Elsevier, vol. 113(3), pages 258-269.
    14. Pauline Allen & Will Bartlett & Virginie Perotin & Bernarda Zamora & Simon Turner, 2011. "New Forms Of Provider In The English National Health Service," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 82(1), pages 77-95, March.
    15. Borzaga, Carlo & Fazzi, Luca, 2014. "Civil society, third sector, and healthcare: The case of social cooperatives in Italy," Social Science & Medicine, Elsevier, vol. 123(C), pages 234-241.
    16. Grabowski, David C. & Feng, Zhanlian & Hirth, Richard & Rahman, Momotazur & Mor, Vincent, 2013. "Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 32(1), pages 12-21.
    17. Midttun, Linda & Hagen, Terje P., 2006. "The private–public mix of healthcare: evidence from a decentralised NHS country," Health Economics, Policy and Law, Cambridge University Press, vol. 1(3), pages 277-298, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Krachler, Nick & Greer, Ian, 2015. "When does marketisation lead to privatisation? Profit-making in English health services after the 2012 Health and Social Care Act," Social Science & Medicine, Elsevier, vol. 124(C), pages 215-223.
    2. Christopher Hoag & Kamal Lamsal, 2014. "Nonprofit Firms in a Linear City with Nonnegative Profits," Working Papers 1403, Trinity College, Department of Economics.
    3. Martin Chalkley, 2018. "Private Provision of Publicly Funded Health Care: The Economics of Ownership," Briefing 002055, Office of Health Economics.
    4. Ge Bai, 2013. "How Do Board Size and Occupational Background of Directors Influence Social Performance in For-profit and Non-profit Organizations? Evidence from California Hospitals," Journal of Business Ethics, Springer, vol. 118(1), pages 171-187, November.
    5. Joana Cima & Alvaro S Almeida, 2018. "Health Expenditure, GDP Growth and the Financial Crisis: A Panel Data Analysis for OECD European Countries," FEP Working Papers 602, Universidade do Porto, Faculdade de Economia do Porto.
    6. Albert H. Choi, 2015. "Non-Profit Status and Relational Sanctions: Commitment to Quality through Repeat Interactions and Organizational Choice," Journal of Law and Economics, University of Chicago Press, vol. 58(4).
    7. Matthias Klumpp & Dominic Loske & Silvio Bicciato, 2022. "COVID-19 health policy evaluation: integrating health and economic perspectives with a data envelopment analysis approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(8), pages 1263-1285, November.
    8. Carmen Guzmán & Francisco J. Santos & Teresa Savall, 2024. "How to explain social innovation in elderly care services: The role of for-profit and non-profit social enterprises," International Entrepreneurship and Management Journal, Springer, vol. 20(3), pages 1849-1877, September.
    9. Genevieve Coderre-LaPalme & Ian Greer & Lisa Schulte, 2023. "Welfare, Work and the Conditions of Social Solidarity: British Campaigns to Defend Healthcare and Social Security," Work, Employment & Society, British Sociological Association, vol. 37(2), pages 352-372, April.
    10. Lauren Xiaoyuan Lu & Susan Feng Lu, 2022. "Does Nonprofit Ownership Matter for Firm Performance? Financial Distress and Ownership Conversion of Nursing Homes," Management Science, INFORMS, vol. 68(7), pages 5127-5145, July.
    11. Cuadrado, Cristóbal & Crispi, Francisca & Libuy, Matías & Marchildon, Gregory & Cid, Camilo, 2019. "National Health Insurance: A conceptual framework from conflicting typologies," Health Policy, Elsevier, vol. 123(7), pages 621-629.
    12. Atul Gupta & Sabrina T Howell & Constantine Yannelis & Abhinav Gupta, 2024. "Owner Incentives and Performance in Healthcare: Private Equity Investment in Nursing Homes," The Review of Financial Studies, Society for Financial Studies, vol. 37(4), pages 1029-1077.
    13. Anup Malani & Tomas Philipson & Guy David, 2003. "Theories of Firm Behavior in the Nonprofit Sector. A Synthesis and Empirical Evaluation," NBER Chapters, in: The Governance of Not-for-Profit Organizations, pages 181-216, National Bureau of Economic Research, Inc.
    14. Toshiyuki Sueyoshi & Youngbok Ryu & Ji-Young Yun, 2021. "COVID-19 Response and Prospects of Clean/Sustainable Energy Transition in Industrial Nations: New Environmental Assessment," Energies, MDPI, vol. 14(4), pages 1-30, February.
    15. Sanmarchi Francesco & Esposito Francesco & Bucci Andrea & Toscano Fabrizio & Golinelli Davide, 2021. "Association between Economic Growth, Mortality, and Healthcare Spending in 31 High-Income Countries," Forum for Health Economics & Policy, De Gruyter, vol. 24(2), pages 101-118, December.
    16. Di Giorgio, L. & Filippini, M. & Masiero, G., 2015. "Structural and managerial cost differences in nonprofit nursing homes," Economic Modelling, Elsevier, vol. 51(C), pages 289-298.
    17. Espinosa-González, Ana Belén & Delaney, Brendan C. & Marti, Joachim & Darzi, Ara, 2021. "The role of the state in financing and regulating primary care in Europe: a taxonomy," Health Policy, Elsevier, vol. 125(2), pages 168-176.
    18. Carlo Borzaga & Ermanno Tortia, 2004. "Worker involvement in entrepreneurial nonprofit organizations. Toward a new assessment of workers' perceived satisfaction and fairness," Department of Economics Working Papers 0409, Department of Economics, University of Trento, Italia.
    19. Baltagi, Badi H. & Yen, Yin-Fang, 2014. "Hospital treatment rates and spillover effects: Does ownership matter?," Regional Science and Urban Economics, Elsevier, vol. 49(C), pages 193-202.
    20. Bowblis John R. & Brunt Christopher S. & Grabowski David C., 2016. "Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities," Forum for Health Economics & Policy, De Gruyter, vol. 19(1), pages 45-70, June.

    More about this item

    Keywords

    health systems; non-profit organizations; privatization;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:por:fepwps:577. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/fepuppt.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.