Público melhor que Privado

Between 1992 to 2003, the share of public hospitals in Germany has decreased from 45% to 36%, while the proportion of for-profit hospitals rose from 15% to 25%. Is this a good thing?
Using data from the Statistical Offices of the Länder from 2000 to 2003, Annika Herr (2008) compares the cost and technical efficiency of three types of German hospitals: public and for-profit private, and non-profit private. To make a fair comparison between hospitals, cases are weighted by their severity. Severity is measured by the diagnosis (ICD-10) and the length of hospital stay. link
Dr. Herr’s main finding is that “both private and non-profit hospitals are less efficient than public hospitals in Germany.” One of the reasons is that private hospitals were paid a per diem rate, thus increasing the hospitals incentive to increase the hospital length of stay. In 2004, capitation payments were introduced for hospital admissions so this may reduce some of the efficiency difference.
One major issue with this paper–and much of health of health economics–is that it ignores hospital quality. Once we take into account quality, then it is possible that private hospitals may out-preform public hospitals with respect to efficiency. It is also possible that private hospitals may have amenities (e.g., single rooms, newer facilities) that patients value, but do not directly affect their health. On the other hand, private hospitals could be more susceptible to supplier-induced-demand under a per diem reimbursement scheme which could further exacerbate the efficiency differences between public and private hospitals.
Another interesting item to note, Herr does mention that Augurzky et al. (2004) found that in Germany, “public hospitals face a much higher risk of insolvency and closure.”
Cost and technical efficiency of German hospitals: does ownership matter?
Jason Shafrin sobre o estudo de Annika Herr, Health Economics, Volume 17, Issue 9 , Pages1057 – 1071, 13.08.08