Hospital concessions: flexibility in practice

Anneloes Blanken, Geert P.M.R. Dewulf, Mirjam Bult-Spiering

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

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Abstract

Over the last decade hospitals concessions have been increasingly implemented around the world. Nonetheless, concession arrangements are subject to many criticisms, which are to a large extent related to the issue of flexibility. Several authors have expressed concerns as to whether concession arrangements are able to provide the flexibility these need in order to secure optimal qualitative hospital facilities and services in the future. This research is on how flexibility is actually perceived in operational hospital concessions. In a case study, an assessment is made on the extent to which English and Australian hospital concessions incorporate the ability to respond to changing demand patterns for clinical services, i.e. mechanisms that provide the flexibility. The outcomes of the case study analysis show that hospital concessions are difficult or expensive to change during their operational phase. However, this appears not to be a consequence of implementing the concession model in its own, but rather the result of sub-optimally designed contracts and/or procurement processes. It is argued that in order to build hospitals that are able to deliver optimal outcomes over time, in addition to a financial focus, health providers should stress flexibility by setting flexible output specifications. Besides, the contract should incorporate the right incentive structures to make both contract partners responsible for flexibility issues that might arise in the future. These outcomes can be used by future hospital boards willing to implement a concession arrangement for their (partly) new hospital building.
Original languageEnglish
Title of host publication2nd Annual Conference of the Health and Care Infrastructure Research and Innovation Centre: Improving healthcare infrastructures through innovation, 2-3 April 2009, Brighton, United Kingdom
EditorsJ. Abel, J. Barlow, J. Carthey, R. Codinhoto, G. Dewulf, A. Dilani
Place of PublicationLondon, United Kingdom
PublisherHaCIRIC, Imperial College Business School
Pages83-88
Number of pages6
Publication statusPublished - 2 Apr 2009

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Concession
Health
Build-to-order
Procurement
Criticism
Incentive structure

Keywords

  • IR-85428
  • METIS-256748

Cite this

Blanken, A., Dewulf, G. P. M. R., & Bult-Spiering, M. (2009). Hospital concessions: flexibility in practice. In J. Abel, J. Barlow, J. Carthey, R. Codinhoto, G. Dewulf, & A. Dilani (Eds.), 2nd Annual Conference of the Health and Care Infrastructure Research and Innovation Centre: Improving healthcare infrastructures through innovation, 2-3 April 2009, Brighton, United Kingdom (pp. 83-88). London, United Kingdom: HaCIRIC, Imperial College Business School.
Blanken, Anneloes ; Dewulf, Geert P.M.R. ; Bult-Spiering, Mirjam. / Hospital concessions: flexibility in practice. 2nd Annual Conference of the Health and Care Infrastructure Research and Innovation Centre: Improving healthcare infrastructures through innovation, 2-3 April 2009, Brighton, United Kingdom. editor / J. Abel ; J. Barlow ; J. Carthey ; R. Codinhoto ; G. Dewulf ; A. Dilani. London, United Kingdom : HaCIRIC, Imperial College Business School, 2009. pp. 83-88
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abstract = "Over the last decade hospitals concessions have been increasingly implemented around the world. Nonetheless, concession arrangements are subject to many criticisms, which are to a large extent related to the issue of flexibility. Several authors have expressed concerns as to whether concession arrangements are able to provide the flexibility these need in order to secure optimal qualitative hospital facilities and services in the future. This research is on how flexibility is actually perceived in operational hospital concessions. In a case study, an assessment is made on the extent to which English and Australian hospital concessions incorporate the ability to respond to changing demand patterns for clinical services, i.e. mechanisms that provide the flexibility. The outcomes of the case study analysis show that hospital concessions are difficult or expensive to change during their operational phase. However, this appears not to be a consequence of implementing the concession model in its own, but rather the result of sub-optimally designed contracts and/or procurement processes. It is argued that in order to build hospitals that are able to deliver optimal outcomes over time, in addition to a financial focus, health providers should stress flexibility by setting flexible output specifications. Besides, the contract should incorporate the right incentive structures to make both contract partners responsible for flexibility issues that might arise in the future. These outcomes can be used by future hospital boards willing to implement a concession arrangement for their (partly) new hospital building.",
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Blanken, A, Dewulf, GPMR & Bult-Spiering, M 2009, Hospital concessions: flexibility in practice. in J Abel, J Barlow, J Carthey, R Codinhoto, G Dewulf & A Dilani (eds), 2nd Annual Conference of the Health and Care Infrastructure Research and Innovation Centre: Improving healthcare infrastructures through innovation, 2-3 April 2009, Brighton, United Kingdom. HaCIRIC, Imperial College Business School, London, United Kingdom, pp. 83-88.

Hospital concessions: flexibility in practice. / Blanken, Anneloes; Dewulf, Geert P.M.R.; Bult-Spiering, Mirjam.

2nd Annual Conference of the Health and Care Infrastructure Research and Innovation Centre: Improving healthcare infrastructures through innovation, 2-3 April 2009, Brighton, United Kingdom. ed. / J. Abel; J. Barlow; J. Carthey; R. Codinhoto; G. Dewulf; A. Dilani. London, United Kingdom : HaCIRIC, Imperial College Business School, 2009. p. 83-88.

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

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T1 - Hospital concessions: flexibility in practice

AU - Blanken, Anneloes

AU - Dewulf, Geert P.M.R.

AU - Bult-Spiering, Mirjam

PY - 2009/4/2

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N2 - Over the last decade hospitals concessions have been increasingly implemented around the world. Nonetheless, concession arrangements are subject to many criticisms, which are to a large extent related to the issue of flexibility. Several authors have expressed concerns as to whether concession arrangements are able to provide the flexibility these need in order to secure optimal qualitative hospital facilities and services in the future. This research is on how flexibility is actually perceived in operational hospital concessions. In a case study, an assessment is made on the extent to which English and Australian hospital concessions incorporate the ability to respond to changing demand patterns for clinical services, i.e. mechanisms that provide the flexibility. The outcomes of the case study analysis show that hospital concessions are difficult or expensive to change during their operational phase. However, this appears not to be a consequence of implementing the concession model in its own, but rather the result of sub-optimally designed contracts and/or procurement processes. It is argued that in order to build hospitals that are able to deliver optimal outcomes over time, in addition to a financial focus, health providers should stress flexibility by setting flexible output specifications. Besides, the contract should incorporate the right incentive structures to make both contract partners responsible for flexibility issues that might arise in the future. These outcomes can be used by future hospital boards willing to implement a concession arrangement for their (partly) new hospital building.

AB - Over the last decade hospitals concessions have been increasingly implemented around the world. Nonetheless, concession arrangements are subject to many criticisms, which are to a large extent related to the issue of flexibility. Several authors have expressed concerns as to whether concession arrangements are able to provide the flexibility these need in order to secure optimal qualitative hospital facilities and services in the future. This research is on how flexibility is actually perceived in operational hospital concessions. In a case study, an assessment is made on the extent to which English and Australian hospital concessions incorporate the ability to respond to changing demand patterns for clinical services, i.e. mechanisms that provide the flexibility. The outcomes of the case study analysis show that hospital concessions are difficult or expensive to change during their operational phase. However, this appears not to be a consequence of implementing the concession model in its own, but rather the result of sub-optimally designed contracts and/or procurement processes. It is argued that in order to build hospitals that are able to deliver optimal outcomes over time, in addition to a financial focus, health providers should stress flexibility by setting flexible output specifications. Besides, the contract should incorporate the right incentive structures to make both contract partners responsible for flexibility issues that might arise in the future. These outcomes can be used by future hospital boards willing to implement a concession arrangement for their (partly) new hospital building.

KW - IR-85428

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M3 - Conference contribution

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BT - 2nd Annual Conference of the Health and Care Infrastructure Research and Innovation Centre: Improving healthcare infrastructures through innovation, 2-3 April 2009, Brighton, United Kingdom

A2 - Abel, J.

A2 - Barlow, J.

A2 - Carthey, J.

A2 - Codinhoto, R.

A2 - Dewulf, G.

A2 - Dilani, A.

PB - HaCIRIC, Imperial College Business School

CY - London, United Kingdom

ER -

Blanken A, Dewulf GPMR, Bult-Spiering M. Hospital concessions: flexibility in practice. In Abel J, Barlow J, Carthey J, Codinhoto R, Dewulf G, Dilani A, editors, 2nd Annual Conference of the Health and Care Infrastructure Research and Innovation Centre: Improving healthcare infrastructures through innovation, 2-3 April 2009, Brighton, United Kingdom. London, United Kingdom: HaCIRIC, Imperial College Business School. 2009. p. 83-88