Hospital Care: Private Assets for-a-Profit?

  • Patrick JeurissenEmail author
  • Hans Maarse


The context for health and hospital care will continue to change greatly. One area of change is ownership, between public, public-private partnership, private not-for-profit, and private for-profit. There are differences between formal and effective control, given that almost everywhere the state has a major role. Pseudo-markets can be created by a purchaser-provider split. Measurable performance differences between the various types is often ambiguous. Perhaps surprisingly, public hospitals are as efficient as private ones, but responsiveness is less. There should be different governance constraints to recognize the different types of provider. Guaranteeing universal access will require care in terms of contractability and accountability considerations, and bailout possibilities.


Accountability Bailout Contractability Effective control  Efficient Formal control  For-profit Governance Not-for-profit Ownership Private Pseudo-markets Public Public-private partnership Purchaser-provider split Responsiveness Universal access 


  1. Augurzky, B., Engel, S., Krolop, C., Schmidt, M., & Terkatz, S. (2007). Hospital Rating Report 2006, Approaches to the Sustainable Financing of Patient Care and Treatment – Development of German Hospitals up to 2010. Essen: RWI-Heft 33.Google Scholar
  2. Augurzky, B., Pilny, A., & Wübker, A. (2015). Krankenhäuser in privater Trägerschaft 2015. Essen: RWI Materialien 89.Google Scholar
  3. Barlow, J. G., Roehrich, J. K., & Wright, S. (2013). Europe sees Mixed Results from Public-private Partnerships for Building and Managing Health Care Facilities and Services. Health Affairs, 32(1), 146–154.Google Scholar
  4. Carter, R. B., Massa, I. J., & Power, M. L. (1997). An Examination of the Efficiency of Proprietary Hospital Ownership versus Non-Proprietary Hospital Ownership Structures. Journal of Accounting and Public Policy, 16, 63–87.CrossRefGoogle Scholar
  5. Comendeiro-Maaloe, M., Ridao-Lopez, M., Gorgemans, S., & Bernal-Delgado, E. (2018). A Comparative Performance Analysis of a Renowned Public Private Partnership for Health Care Provision in Spain Between 2003 and 2015. Health Policy.
  6. Eggleston, K., Shen, Y. C., Lau, J., Schmidt, C. H., & Chan, J. (2006). Hospital Ownership and Quality of Care: What Explains the Different Results? NBER Working Paper 12241.Google Scholar
  7. Feldstein, P. J. (1979). Healthcare Economics. New York: John Wiley & Sons.Google Scholar
  8. Hansmann, H. (1980). The Role of Nonprofit Enterprise. Yale Law Journal, 89, 835–890.CrossRefGoogle Scholar
  9. Hansmann, H., Kessler, D., & McClellan, M. (2002). Ownership Form and Trapped Capital in the Hospital Industry. NBER, Working Paper 8989.Google Scholar
  10. Herr, A. (2008). Costs and Technical Efficiency of German Hospitals: Does Ownership Matter? Health Economics, 17, 1057–1071.CrossRefGoogle Scholar
  11. Higgins, J. (1988). The Business of Medicine: Private Healthcare in Britain. London: Macmillan.CrossRefGoogle Scholar
  12. Jeurissen, P. P. T. (2010). For-Profit Hospitals. A Comparative and Longitudinal Study of the For-Profit Hospital Sector in Four Western Countries. Rotterdam: Erasmus University. Dissertation.Google Scholar
  13. Klijn, E. H., Edelenbos, J., & Hughes, M. (2007). Public-Private Partnership: A Two-Headed Reform. A Comparison of PPP in England and the Netherlands. In C. Pollitt, S. van Thiel, & V. Homburg (Eds.), New Public Management in Europe Adaption and Alternatives (pp. 71–89). New York: Palgrave Macmillan.Google Scholar
  14. Kruse, F. M., Stadhouders, N. W., Adang, E., Groenewoud, S., & Jeurissen, P. P. T. (2018). Do Private Hospitals Outperform Public Hospitals Regarding Efficiency, Accessibility, and Quality of Care in the European Union? A Literature Review. International Journal Health Planning and Management, 33(2), e434–e453.CrossRefGoogle Scholar
  15. Laing & Buisson. (2007). Laing’s Healthcare Market Review 2007–2008 (20th ed.). Bedfordshire: Newnorth Print Ltd.Google Scholar
  16. Montagu, D., & Harding, A. (2012). A Zebra or a Painted Horse? Are Hospital PPPs Infrastructure Partnerships with Stripes or a Separate Species. World Hospitals and Health Services, 48(2), 15–20.Google Scholar
  17. NAO – National Audit Office. (2018). PFI and PF2, Report by the Comptroller and Auditor General, January 12, 2018. Retrieved from
  18. Naylor, C., & Gregory, S. (2009, October). Briefing: Independent Sector Treatment Centres. London: Kings Fund.Google Scholar
  19. OECD. (2018). OECD Stat. Retrieved April 1, 2019, from
  20. Pauly, M. V., & Redisch, M. (1973). The Non-Profit Hospital as a Physicians’ Cooperative. American Economic Review, 63, 87–99.Google Scholar
  21. Schlesinger, M., & Gray, B. H. (2006). How Nonprofits Matter in American Medicine, and What to Do About It. Health Affairs, w287–w303.Google Scholar
  22. Simon, M. (2000). Krankenhauspolitik in der Bundesrepublik Deutschland, Historische Entwicklung und Probleme der Politisches Steuerung stationärer Krankenversorgung. Wiesbaden: Westdeutscher Verlag.Google Scholar
  23. Toffolutti, V., Reeves, A., McKee, M., & Stuckler, D. (2017). Outsourcing Cleaning Services Increase MRSA Incidence: Evidence from 126 English Acute Trusts. Social Science and Medicine, 174, 64–69.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2020

Authors and Affiliations

  1. 1.Radboud University Medical SchoolNijmegenNetherlands
  2. 2.Ministry of Health, Welfare and SportsHagueNetherlands
  3. 3.Faculty of Health, Medicine and Life Sciences, University of MaastrichtMaastrichtNetherlands

Personalised recommendations