Flexibility against efficiency? an international study on value for money in hospital concessions

Anneloes Blanken

    Research output: ThesisPhD Thesis - Research UT, graduation UT

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    Recently, the mechanisms adopted by governments for the provision of hospitals have changed considerably, with the concession arrangement gaining in popularity. A hospital concession concerns an arrangement between public and private organizations for the provision of a hospital, in which the private sector designs, builds, finances, and maintains it; for which it is reimbursed by the public organization based on the services delivered in the hospital it has provided. Hospital concessions are seen as a solution to overcome the bottlenecks associated with the conventional approach to hospital provision. However, despite hospital concessions being increasingly implemented, they represent a major, but so far under-evaluated, concept. Little research has been completed on the performances of these hospital concessions. Generally, they are studied based on the preconceptions of the actors involved, rather than on operational and scientific outcomes of the project since adequate assessment methods are absent. Moreover, there is little evidence on how context and project characteristics affect concession performance. The lack of empirical data, especially during the operational stage of concessions, makes a rigorous scrutiny of concessions impossible. It is therefore not surprising to observe that the debate surrounding hospital concessions is dominated by opinions that are largely based on normative assumptions. This study has tried to progress from these normative standpoints through insights derived from in-depth analyses of projects. It has endeavored to assess the potential of hospital concessions and their empirical performance in addressing the underdeveloped issues described above. The study started with two propositions: (1) while the market for hospital concessions is dominated by legal and financial advisors, the contracts underlying hospital concessions are significant determinants of concession performance; and (2) based on the claim that structure follows strategy, this contract will be tuned to project-specific needs of each concession as well as to the macroeconomic context surrounding it. The central question in this study is formulated as what is the performance of hospital concessions, and what are the determinants that deliver this performance? Providing an answer was structured through the development of two research products: (1) a performance tool which would be appropriate for the empirical assessment of operational hospital concessions; and (2) an empirical assessment of the performance of operational hospital concessions within their individual contexts.
    Original languageEnglish
    Awarding Institution
    • University of Twente
    • Dewulf, Geert Pol Mimi Remi, Supervisor
    • Bult-Spiering, W.D., Supervisor
    Award date3 Apr 2008
    Place of PublicationEnschede
    Print ISBNs978-90-365-2648-7
    Publication statusPublished - 3 Apr 2008


    • IR-58849

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