BACKGROUND In developed countries around the world there is a trend to enhance the public-private collaboration in healthcare. In Spain, a decentralized country with a NHS funded with taxes and universal coverage, commissioning to for-profit private hospitals the production of healthcare services to specific patients that are publicly insured is a traditional practice. Around 43% of the for-profit private hospitals in Spain have a commissioning agreement with the NHS to diagnose or treat patients on public tariffs. These revenues represent 26% of the total revenues of private for-profit hospitals. The research question of this study is if commissioning with the NHS improves the financial performance of private-for-profit hospitals in Spain. METHODS With a long panel (2000-2017) of for-profit hospitals we estimate a model for the financial performance (return on assets) using commissioning as main explanatory variable and other variables as control (variables financial indicators and structural information). Specific models are estimated for subgroups of hospitals according to size and specialization. The models are estimated by panel regression with fixed effects and GMM as robustness. RESULTS Private for-profit hospitals that have commissioning with NHS obtain higher financial performance than no-commissioning hospitals. This effect varies depending on hospital size and type (hospital specialization), the advantage being more relevant for general hospitals and particularly for hospital with at least 50 beds. CONCLUSIONS Commissioning with the NHS is a promising source of financial profitability for general acute private for-profit hospitals. The evidence provided by this study may orientate the NHS in the regulation and negotiation of commissioning contracts in healthcare.

中文翻译：

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与NHS提供医疗服务的安排：它们是否改善了西班牙私人营利性医院的财务绩效？

背景技术在世界各地的发达国家中，存在增强医疗保健中的公私合作的趋势。在西班牙，一个拥有NHS税费和全民医保资金的分散国家，委托盈利性私立医院为公共保险的特定患者提供医疗服务是一种传统做法。西班牙约有43％的营利性私立医院与NHS签订了委托协议，以公共收费诊断或治疗患者。这些收入占私人营利性医院总收入的26％。这项研究的研究问题是，与NHS的合作是否可以改善西班牙私立营利性医院的财务绩效。方法在一个由营利性医院组成的小组（2000-2017年）中，我们使用委托作为主要的解释变量，而其他变量作为对照（变量财务指标和结构信息），估计财务绩效（资产收益）的模型。根据规模和专业性，为医院的亚组估计特定的模型。通过具有固定效果的面板回归和GMM作为稳健性来估计模型。结果接受NHS委托的私人营利性医院比没有委托的医院获得更高的财务业绩。该效果因医院规模和类型（医院专业）而异，其优势与普通医院尤其是至少有50张床位的医院有关。结论使用NHS进行调试对于普通的急性私人营利性医院是财务盈利能力的有希望的来源。这项研究提供的证据可以使NHS定位于医疗保健中的委托合同的监管和谈判。