{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T18:59:21Z","timestamp":1790449161764,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp; Management"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The state of S\u00e3o Paulo pioneered the adoption of Social Health Organisations (SHOs) under Complementary Law No. 846\/1998 that would allow private non\u2010profit organisations to manage hospitals and health services under government contracts with the aim of gaining efficiency and improving quality of care. Our study evaluates whether the management of hospitals by SHOs is associated with improvements in system performance for patients diagnosed with breast, prostate and colorectal cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 652,734 registered breast, prostate, and colorectal cancer cases diagnosed from 2000 to 2023 across an 80\u2010hospital analytic roster. The primary staggered difference\u2010in\u2010differences analysis compared SHO adopters with directly administered public hospitals, used hospital\u2010quarter observations with equal hospital weighting, and applied outcome\u2010specific mortality follow\u2010up restrictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The restricted primary analyses included 23\u201324 public hospitals, depending on the outcome. SHO adoption was associated with imprecise changes in diagnosis\u2010to\u2010treatment time (\u2212155.3\u00a0days; 95% CI \u2212350.0 to 39.4), consultation\u2010to\u2010diagnosis time (\u221296.3\u00a0days; 95% CI \u2212237.7 to 45.1), 30\u2010day mortality (0.8 percentage points; 95% CI \u22124.0 to 5.5), 1\u2010year mortality (2.5 percentage points; 95% CI \u221221.7\u201326.8), and 5\u2010year mortality (29.6 percentage points; 95% CI \u22123.6 to 62.8). Estimates changed materially with the control group and weighting approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study did not provide precise evidence that SHO adoption improved cancer\u2010care processes or mortality. However, the small number of hospitals, incomplete long\u2010term follow\u2010up, sensitivity to weighting and control definitions, and\u00a0the inability to estimate a joint pre\u2010trends test mean that clinically important effects in either direction cannot be excluded.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hpm.70143","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T18:44:52Z","timestamp":1790448292000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital Management Models and Cancer Care Outcomes in Brazil: Evidence From a Staggered Difference\u2010in\u2010Differences Study in S\u00e3o Paulo"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3562-3246","authenticated-orcid":false,"given":"Felipe Mendes","family":"Delpino","sequence":"first","affiliation":[{"name":"Center for Studies and Promotion of Health Policies Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6695-0496","authenticated-orcid":false,"given":"Francisco","family":"Tustumi","sequence":"additional","affiliation":[{"name":"Center for Studies and Promotion of Health Policies Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina Martins","family":"Siqueira","sequence":"additional","affiliation":[{"name":"Center for Studies and Promotion of Health Policies Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriely Rangel","family":"Pereira","sequence":"additional","affiliation":[{"name":"Center for Studies and Promotion of Health Policies Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5511-8626","authenticated-orcid":false,"given":"Lucas Hernandes","family":"Correa","sequence":"additional","affiliation":[{"name":"Center for Studies and Promotion of Health Policies Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Health Policy The London School of Economics and Political Science  London UK"},{"name":"Centre for Primary Care and Health Services Research The University of Manchester  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laia","family":"Maynou","sequence":"additional","affiliation":[{"name":"Department of Health Policy The London School of Economics and Political Science  London UK"},{"name":"Department of Econometrics, Statistics and Applied Economics and IEB Universitat de Barcelona  Barcelona Spain"},{"name":"Center for Research in Economics and Health (CRES) Universitat Pompeu Fabra  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meskerem Aleka","family":"Kebede","sequence":"additional","affiliation":[{"name":"Department of Health Policy The London School of Economics and Political Science  London UK"},{"name":"Global Surgery Policy Unit LSE Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Hargest","sequence":"additional","affiliation":[{"name":"Global Surgery Policy Unit LSE Health  London UK"},{"name":"University Hospital of Wales  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Wolosker","sequence":"additional","affiliation":[{"name":"Center for Studies and Promotion of Health Policies Hospital Israelita Albert Einstein  S\u00e3o Paulo 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