Rural vs urban hospital performance in a 'competitive' public health service

Social Science & Medicine
Javier García-Lacalle, Emilio Martín

Abstract

In some western countries, market-driven reforms to improve efficiency and quality have harmed the performance of some hospitals, occasionally leading to their closure, mostly in rural areas. This paper seeks to explore whether these reforms affect urban and rural hospitals differently in a European health service. Rural and urban hospital performance is compared taking into account their efficiency and perceived quality. The study is focused on the Andalusian Health Service (SAS) in Spain, which has implemented a freedom of hospital choice policy and a reimbursement system based on hospital performance. Data Envelopment Analysis, the Mann-Whitney U test and Multidimensional Scaling techniques are conducted for two years, 2003 and 2006. The results show that rural and urban hospitals perform similarly in the efficiency dimension, whereas rural hospitals perform significantly better than urban hospitals in the patient satisfaction dimension. When the two dimensions are considered jointly, some rural hospitals are found to be the best performers. As such, market-driven reforms do not necessary result in a difference in the performance of rural and urban hospitals.

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Citations

Jan 30, 2013·International Journal of Environmental Research and Public Health·Meirong SuJiao Wang
Jan 25, 2013·Health Economics, Policy, and Law·Javier García-Lacalle, Emilio Martín
Apr 15, 2015·Gaceta sanitaria·Luis Herrero TabaneraMa del Puerto López del Amo González
Apr 12, 2014·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Mehmet Sahin Gok, Erkut Altındağ
Mar 30, 2017·PloS One·Monica GiancottiMarianna Mauro
Feb 27, 2018·Health Care Management Science·Sebastian KohlJens O Brunner
Dec 11, 2019·International Journal of Environmental Research and Public Health·María Del Carmen Valls Martínez, Alicia Ramírez-Orellana
Mar 4, 2021·International Journal of Environmental Research and Public Health·María Del Carmen Valls MartínezMayra Soledad Grasso

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