[New hospital management models as an alternative for the sustainability of public hospital system: An analysis of efficiency in health expenditure]. / Los nuevos modelos de gestión de hospitales como alternativa para la sostenibilidad del sistema hospitalario público: un análisis de eficiencia en gasto sanitario.

OBJECTIVE: To analyse the efficiency in health expenditure of the new hospital management models (Private Finance Initiative [PFI], Public Private Partnership [PPP] and other new management models) compared to the traditional management, with the objective of determining which is the more sustainable and efficient. MATERIAL AND METHODS: The efficiency was measured in health expenditure terms of the different general hospitals management models in the period 2009-2016, using data envelopment analysis (DEA). The study included a population of 7 hospitals with a PFI model, a population of 3 hospitals with a PPP model, a population of 4 hospitals with other new management models, and a population of 11 public hospitals with direct public management by the Madrid Health Service (SERMAS). RESULTS: The highest mean health expenditure efficiency corresponded to the PPP model (85.8%), followed by the PFI model (73.5%), and the other new management models (56.6%). The lowest mean health expenditure efficiency corresponded to the direct public management model, with 53.3%. As regards changes in productivity, measured by the Malmquist Index, there were increases amounting to 1.1% in the PPP model, 1% in the PFI model, 1.8% in traditional management, and a decrease of 3.8% in the other new management models. CONCLUSIONS: Hospitals governed by new management models had a higher health expenditure efficiency, and from the health expenditure point of view they are an alternative to be considered in the planning of new health infrastructures.