title: Payments and quality of care in private for-profit and public hospitals in Greece.
abstract: BACKGROUND
  Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged.
  
  
  METHODS
  Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003.
  
  
  RESULTS
  PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities.
  
  
  CONCLUSIONS
  In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.
authors.affiliation: Greek Observatory on the Privatization of Health Care, Aristotle University, 54124 Thessaloniki, Greece. eliaskon@med.auth.gr
authors.forename: Elias
authors.initials: E
authors.lastname: Kondilis
authors.forename: Magda
authors.initials: M
authors.lastname: Gavana
authors.forename: Stathis
authors.initials: S
authors.lastname: Giannakopoulos
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Smyrnakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dombros
authors.forename: Alexis
authors.initials: A
authors.lastname: Benos
mesh_terms: D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006115:Greece; D017048:Health Care Costs; D019538:Health Care Surveys; D005102:Health Expenditures; D006269:Health Facilities, Proprietary / Q000458:organization & administration; D054625:Healthcare Disparities / Q000191:economics; D016304:Hospitals, Private / Q000191:economics* / Q000592:standards; D006779:Hospitals, Public / Q000191:economics* / Q000592:standards; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D018570:Risk Assessment; D012959:Socioeconomic Factors