Influence of the PPP management model on the efficiency of healthcare management

Introduction The first Health District (HD) to be managed privately but with public financing (PPP) was established in 2003. Following this model, between 2010 and 2018, five of the 24 HDs of the Valencia Community ( Comunidad Valenciana) (CV), a region in the South of Europe, were simultaneously managed under this modality. In 2018, the first comprehensive PPP contract ended and currently, only one Heath District remains under this modality in this region, whose contract has been extended for another five years (until 2030). Objective The PPP management model was created with the aim of being more efficient than the traditional direct management model. The purpose of this article is to compare the efficiency of both healthcare management models to determine which is more efficient. Methodology Variables related to activity carried out at both levels of healthcare (primary and specialized) are used, as well as indicators of use and patient satisfaction for the 24 HDs in the Valencia Community (Spain) in the years 2016, 2017 and 2018. These are the last three years in which the five above mentioned HDs were managed under the PPP modality. We use Data Envelopment Analysis (DEA) to analyse the efficiency of the HDs in this geographic area (CV), which covers a population of approximately 5 million inhabitants, of which approximately 1 million (20% of the total population) were assigned in these years to one of the five HDs managed under the comprehensive PPP management formula. In addition, a Tobit regression analysis is included whose dependent variable is the efficiency index obtained in the DEA, thus making it a censored dependent variable. Results and conclusions The HDs managed under the PPP modality obtained both the best and worst results in terms of efficiency, showing that the type of management does not guarantee the efficiency of the HD. Therefore, other factors must be involved, such as the geographical location, the management team, or even the company awarded each PPP contract. Patient satisfaction showed a direct and positive relationship with HD efficiency.