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]
Comparing public, contractor and private hospitals: evaluation of outcomes of care
Published 12 September 2006