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Gesundheitswesen. 2012 Jun;74(6):379-86. doi: 10.1055/s-0031-1280844. Epub 2011 Jul 27.

[Are privately owned hospitals more efficient? Results of a survey of the international literature].

[Article in German]

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Institute for International Health Management, Frankfurt School of Finance & Management, Sonnemannstraße 9–11, 60314 Frankfurt am Main.



In no other European country has the privatisation of hospitals taken such dimensions in the last 15 years as in Germany. Thereby a higher efficiency of private ownership is often assumed as a potential driver.


The aim of this study is to analyse the current state of research on the question of whether private hospitals are more efficient, or whether the public ones are just plain worse operators of clinics.


As a contribution to answering the relevant question, a systematic review of the international literature on benchmarking the performance of hospitals as a function of ownership on the basis of the efficiency measurement using DEA (data envelopment analysis) was conducted.


In the closer analysis 8 studies were accepted; of which 3 refer to the U.S.A., 3 to the German and one to the Taiwanese and South Korean health-care sector. These studies compare private hospital operators with other types of ownership, where they differ considerably in their methodological approaches. 5 studies reveal that public and not-for-profit hospitals are more efficient than those in private ownership. One study concludes the opposite, and 2 could not demonstrate any significant differences between the different hospital ownerships.


This result is a surprise taking into consideration the development and discussion in Germany in recent years and in comparison to studies based on alternative approaches to efficiency measurement. The detailed analysis of the studies shows that because of weaknesses and a variety of differences in the methodological structure of the studies a really convincing answer regarding the first question ultimately cannot be derived from the results.

[Indexed for MEDLINE]

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