Quality of Care in Contracted-out and Directly Provided Public Hospital Services in South Africa: Evaluation of Structural Aspects

This paper evaluates structural quality of hospital care in the context of an evaluation of contracting out district hospital services in South Africa. Three contractor hospitals, run by a private company and paid by public purchasers to provide district hospital care to a rural catchment population, were matched with three adjacent public hospitals and three private hospitals serving largely insured patients. A structured instrument was used to provide a quantitative measure of structural quality. Private hospitals scored highest overall, followed by public and then contractor hospitals. Contractor hospitals appeared to limit the quantity and quality of key inputs, including critical staffing and equipment and supplies, to the point of failing to meet what the evaluation defined as realistic public sector standards. On the other hand, the contractors demonstrated clearly superior provision and maintenance of hospital buildings and amenities. The study suggests scope for improved specification and monitoring of structural quality of care in the contracting process. [From abstract]