Benefits of private hospital management on the quality of health care within a value-based system: a controlled cohort analysis of tertiary Spanish hospitals

Abstract Background Value-based healthcare (VBHC) is a care delivery model that seeks to maximize patient outcomes while optimizing resource utilization through systematic outcome measurement, integrated care pathways, and aligned organizational incentives. This study compared indicators of patient safety and quality of care, efficiency, and patient experience between publicly managed tertiary hospitals and a publicly owned tertiary hospital outsourced to a value-based healthcare network. Methods We performed a retrospective case-control analysis of eight tertiary care hospitals from the Madrid (Spain) Regional Health Service, one privately managed under a value-based model (study hospital) and seven publicly managed. We analyzed indicators of quality of care and patient safety (standardized hospital mortality, complication and infection rates), efficiency (length of stay, surgical backlog), and patient satisfaction (surveys scores and hospital choice rates). Data were collected from official publicly available annual data (2015–2022) from the regional health authority. Results No significant differences in case mix complexity were observed between hospitals. The study hospital, the only one among the eight tertiary hospitals that is privately managed under a value-based model, and representing over 10 million care episodes during the study period, showed significantly lower standardized hospital mortality rate (SHMR), inpatient complications (RR 0.87; p = 0.032) and hospital-acquired infections (RR 0.62; P < 0.001) than the control group. Length of stay and case mix-adjusted average inpatient length of stay (CMAILS) were significantly lower than the reference value for the study hospital, with lower mean surgical backlog (14.8 vs. 67.2 days; P < 0.001) than the control group. Average yearly number of patients choosing to transfer to the study hospital was higher than the average of the control group (57,688 vs. 9,291; p < 0.001). Conclusions Publicly available, official data on value-based outsourcing in a regional healthcare service offering universal access to care provides evidentiary support that outsourcing public hospital management to a value-based network is associated with improved quality indicators of care and patient safety, healthcare system efficiency, and patient satisfaction. This study suggests that this form of outsourcing can serve as a catalyst for value-based transformation across the healthcare system.