Purpose: To identify any differences in the outcomes of medical care between contractor, public, and private hospitals, in the context of a study of whether or not the South African government should provide district hospital services itself, or contract out their management to the private sector.
Methods: The three contractor hospitals were paired with three adjacent public hospitals and three private hospitals. Tracer conditions (appendectomy, hernia repair, normal delivery, caesarean section) were studied, with quality defined in terms of the presence or absence of poor outcomes of care. An audit system was used to assess the extent to which peri-natal deaths were avoidable.
Findings: There were no sustained or systematic differences between health outcomes in contractor or public hospitals, except for avoidable factors in peri-natal deaths where contractor hospitals scored worse. There was much evidence suggesting serious quality of care problems in both contractor and public hospitals.
Conclusions: The contractual arrangement did not appear to lead to either better or worse outcome quality; however quality did not feature either in contract specification or in monitoring arrangements. Quality of care was potentially capable of much improvement, and better contract specification would contribute to this.
Broomberg, J.; Mills, A. Comparing public, contractor and private hospitals: evaluation of outcomes of care. London School of Hygiene and Tropical Medicine, London, UK (2004) 30 pp. [HEFP working paper 04/04]