The impact of New Public Management on efficiency: an analysis of Madrid's hospitals.

Madrid has recently become the site of one of the most controversial cases of public healthcare reform in the European Union. Despite the fact that the introduction of New Public Management (NPM) into Madrid hospitals has been vigorous, little scholarship has been done to test whether NPM actually led to technical efficiency. This paper is one of the first attempts to do so. We deploy a bootstrapped data envelopment analysis to compare efficiency scores in traditionally managed hospitals and those operating with new management formulas. We do not find evidence that NPM hospitals are more efficient than traditionally managed ones. Moreover, our results suggest that what actually matters may be the management itself, rather than the management model.

[1]  Judith Clifton,et al.  Privatizing public enterprises in the European Union 1960–2002: ideological, pragmatic, inevitable? , 2006 .

[2]  P. Jensen,et al.  Incentives and the Efficiency of Public Sector-Outsourcing Contracts , 2005 .

[3]  Jan-Erik Lane,et al.  New Public Management , 2021, Bangladesh Journal of Public Administration.

[4]  C. Hood A PUBLIC MANAGEMENT FOR ALL SEASONS , 1991 .

[5]  Zhongsheng Hua,et al.  DEA with Undesirable Factors , 2007 .

[6]  Leâ Opold Simar,et al.  A general methodology for bootstrapping in non-parametric frontier models , 2000 .

[7]  M. Mckee,et al.  Will austerity cuts dismantle the Spanish healthcare system? , 2013, BMJ.

[8]  Pamela Stapleton,et al.  Spanish healthcare Public Private Partnerships: the ?Alzira model , 2011 .

[9]  Tom Christensen,et al.  The Ashgate Research Companion to New Public Management , 2010 .

[10]  A. Guillén,et al.  ‘Southern‐style’ National Health Services? Recent Reforms and Trends in Spain and Greece , 2008 .

[11]  M. Bayle,et al.  The People's Campaign against Health Care Counter-Reforms in Spain , 2001 .

[12]  B. Hollingsworth Non-Parametric and Parametric Applications Measuring Efficiency in Health Care , 2003, Health care management science.

[13]  O. Hart,et al.  The Proper Scope of Government: Theory and an Application to Prisons , 1996 .

[14]  Marion S. Rauner,et al.  A cross-national comparison and taxonomy of DEA-based hospital efficiency studies , 2008 .

[15]  W. B. Liu,et al.  DEA models with undesirable inputs and outputs , 2010, Ann. Oper. Res..

[16]  P. W. Wilson,et al.  Sensitivity Analysis of Efficiency Scores: How to Bootstrap in Nonparametric Frontier Models , 1998 .

[17]  E. Hanushek,et al.  The revolving door: A path-breaking study of teachers in Texas reveals that working conditions matter more than salary. , 2004 .

[18]  Juan Oliva,et al.  Gestión pública y gestión privada de servicios sanitarios públicos: más allá del ruido y la furia, una comparación internacional , 2013 .

[19]  R. Saltman,et al.  Governing Public Hospitals , 2015 .

[20]  E. Bernal-Delgado,et al.  Spain: Health system review. , 2010, Health systems in transition.

[21]  Yauheniya Varabyova,et al.  International comparisons of the technical efficiency of the hospital sector: panel data analysis of OECD countries using parametric and non-parametric approaches. , 2013, Health policy.

[22]  Yasar A. Ozcan,et al.  Public Sector Hospital Efficiency for Provincial Markets in Turkey , 2000, Journal of Medical Systems.

[23]  Jonas Schreyögg,et al.  EFFECTS OF OWNERSHIP ON HOSPITAL EFFICIENCY IN GERMANY. , 2009 .

[24]  Pablo Arocena,et al.  Accounting for quality in the measurement of hospital performance: evidence from Costa Rica. , 2007, Health economics.

[25]  P. W. Wilson,et al.  Statistical Inference in Nonparametric Frontier Models: The State of the Art , 1999 .

[26]  D. Simonet The New Public Management Theory in the British Health Care System , 2015 .

[27]  Paul W. Wilson,et al.  FEAR: A software package for frontier efficiency analysis with R , 2008 .

[28]  Stephen Gibbons,et al.  Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms , 2011, Economic journal.

[29]  R. Andrews NPM and the Search for Efficiency , 2010 .

[30]  B. Hollingsworth The measurement of efficiency and productivity of health care delivery. , 2008, Health economics.

[31]  S. Wright,et al.  Europe Sees Mixed Results from Public-Private Partnerships for Building and Managing Health Care Facilities and Services , 2013, Health affairs.

[32]  A. Charnes,et al.  Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis , 1984 .

[33]  José Martín Nuevas fórmulas de gestión en las organizaciones sanitarias , 2003 .

[34]  A. Street Purchaser/provider separation and managed competition: reform options for Australia's health system. , 2010, Australian journal of public health.

[35]  Jstor Journal of the Royal Statistical Society. Series A (General) , 1987 .

[36]  R. Banker Estimating most productive scale size using data envelopment analysis , 1984 .

[37]  Eran Vigoda New Public Management , 2007 .

[38]  L. Toop NHS plc: The Privatisation of Our Health Care , 2004 .

[39]  A. Ferrari The internal market and hospital efficiency: a stochastic distance function approach , 2006 .

[40]  Lawrence M. Seiford,et al.  Modeling undesirable factors in efficiency evaluation , 2002, Eur. J. Oper. Res..

[41]  R. RajivD.BANKE Estimating most productive scale size using data envelopment analysis , 2003 .

[42]  Abraham Charnes,et al.  Measuring the efficiency of decision making units , 1978 .

[43]  M. Farrell The Measurement of Productive Efficiency , 1957 .

[44]  W. Cooper,et al.  Data Envelopment Analysis: A Comprehensive Text with Models, Applications, References and DEA-Solver Software , 1999 .

[45]  E. Sclar The political economics of investment Utopia: public–private partnerships for urban infrastructure finance , 2015 .

[46]  Fernando-Ignacio Sánchez-Martínez,et al.  La privatización de la gestión sanitaria: efecto secundario de la crisis y síntoma de mal gobierno. Informe SESPAS 2014 , 2014 .

[47]  Rolf Färe,et al.  Modeling undesirable factors in efficiency evaluation: Comment , 2004, Eur. J. Oper. Res..

[48]  B. Rechel,et al.  Health Systems in Transition , 2021, Health Management 2.0.

[49]  Raquel Gallego Introducing Purchaser/Provider Separation in the Catalan Health Administration: A Budget Analysis , 2000 .

[50]  A. Pollock,et al.  No evidence that patient choice in the NHS saves lives , 2011, The Lancet.

[51]  Nurhan Davutyan,et al.  Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case , 2014, Ann. Oper. Res..

[52]  J. Gene-Badia,et al.  Cuts drive health system reforms in Spain. , 2013, Health policy.

[53]  A. Pollock,et al.  The Private Financing of NHS Hospitals: Politics, Policy and Practice , 2009 .

[54]  A. Rada Largest healthcare privatisation plan in Spain is to go ahead, despite massive opposition. , 2013 .

[55]  Colin Douglas,et al.  NHS plc: The Privatisation of Our Health Care , 2004, BMJ : British Medical Journal.

[56]  Pamela Stapleton,et al.  New development: New global health care PPP developments—a critique of the success story , 2012 .

[57]  Robert G. Lord,et al.  Academy of Management Proceedings , 2016 .

[58]  Jean Tirole,et al.  The Politics of Government Decision-Making : a Theory of Regulatory Capture , 1991 .

[59]  Rowena Jacobs,et al.  Measuring Efficiency in Health Care: Analytic Techniques and Health Policy , 2006 .

[60]  D. Mayston The Private Finance Initiative in the National Health Service: An Unhealthy Development in New Public Management? , 1999 .

[61]  M. Warner,et al.  Marketisation, public services and the city: the potential for Polanyian counter movements , 2014 .