Financial performance of hospitals in Europe – a scoping review

Background Hospitals constitute an essential part of health systems. Although fragmented data indicate that hospitals in many European countries face financial problems, no structured, comparative data are available. The objective of this study was to identify, synthetize, and map the existing evidence on hospital financial performance (FP) across European countries. Methods A scoping literature review was conducted, following standardized methodological guidelines and a previously published protocol. Four scientific databases (PubMed, Web of Science Core Collection, Scopus, and ProQuest Central) were searched to identify studies published since 2010. The inclusion criteria were as follows: 1) the focus is on hospital settings in a European country; 2) FP is measured at the hospital level using a defined ratio; and 3) the publication is a full text article in English. Results After screening 3165 records, a total number of 57 full text publications focusing on 11 European countries were included (48 empirical studies and nine policy/discussion papers or technical reports). The empirical studies focused on four main categories: 1) measuring and/or comparing hospital FP (n = 17/48); 2) identifying associations between FP and other hospital (mostly organizational) characteristics (n = 33/48); 3) analysing the impact of an event on hospital FP (n = 11/48); and 4) other, e.g. developing a comprehensive hospital performance matrix with FP as one of the dimensions (n = 6/48). The vast majority of empirical studies are quantitative, use secondary data sources, and apply single profitability indicators to measure FP. The identified studies’ results are often mixed and highly specific to context, data, and methods. Conclusions Research evidence on hospital FP in Europe is available for a limited number of countries. The existing empirical studies focus mostly on analysing relationships between hospital FP and other organizational characteristics (e.g. ownership, management style). Our review indicates existence of two major research gaps: 1) a lack of evidence on associations between hospital FP and quality of care metrics; and 2) a need for more theoretical/conceptual work on composite FP metrics that are relevant for hospital care providers.