{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:50:15Z","timestamp":1782301815143,"version":"3.54.5"},"reference-count":30,"publisher":"Gobierno de Navarra","issue":"1","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.es"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["An Sist Sanit Navar"],"abstract":"<jats:p>Fundamento. Este estudio compara la eficiencia de un mismo hospital bajo gesti\u00f3n privada (2015\u20132018) y p\u00fablica (2019\u20132022), evaluando el impacto del periodo pand\u00e9mico (2020\u20132021).\nMetodolog\u00eda. La eficiencia hospitalaria se evalu\u00f3 mediante un modelo de an\u00e1lisis envolvente de datos, orientado a outputs y con retornos variables a escala. Las consultas, urgencias, intervenciones quir\u00fargicas, ingresos hospitalarios y estancias se incluyeron como outputs, considerando un input constante (=1). La robustez se analiz\u00f3 con un bootstrap param\u00e9trico de 1.500 r\u00e9plicas, generando intervalos de confianza e indicadores corregidos por sesgo. Adem\u00e1s, se aplic\u00f3 un an\u00e1lisis de series temporales interrumpidas para proyectar un escenario contrafactual del periodo de gesti\u00f3n privada y compararlo con el de gesti\u00f3n p\u00fablica.\nResultados. La gesti\u00f3n privada alcanz\u00f3 consistentemente niveles de eficiencia cercanos a la frontera durante 2015\u20132018. La gesti\u00f3n p\u00fablica mostr\u00f3 una ca\u00edda abrupta en 2020\u20132021, con valores de eficiencia pr\u00f3ximos a cero. El an\u00e1lisis bootstrap confirm\u00f3 que estas reducciones fueron estad\u00edsticamente significativas y no aleatorias. En 2022 se observ\u00f3 una recuperaci\u00f3n parcial, aunque los niveles de eficiencia se mantuvieron por debajo del escenario contrafactual proyectado.\nConclusiones. Mientras la gesti\u00f3n privada mostr\u00f3 una eficiencia hospitalaria estable, la pandemia impact\u00f3 negativamente la gesti\u00f3n p\u00fablica, con signos de resiliencia en la etapa post-pand\u00e9mica inmediata. La eficiencia hospitalaria es altamente sensible a las crisis externas y a las estructuras de gobernanza. Fortalecer la resiliencia, la digitalizaci\u00f3n y la sostenibilidad constituye una estrategia clave para mantener la eficiencia y la equidad en futuras disrupciones del sistema.<\/jats:p>","DOI":"10.23938\/assn.1162","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:06:08Z","timestamp":1777464368000},"page":"e1162","source":"Crossref","is-referenced-by-count":0,"title":["Eficiencia tras la integraci\u00f3n de un hospital con nuevo modelo de gesti\u00f3n","Efficiency after integrating a hospital with a 'new management model\u2019","OSPITALE-ERAGINKORTASUNA ITZULKETAREN ONDOREN: OSPITALE-KONTZESIO KASU BAT MEDITERRANEOKO EUROESKUALDEAN."],"prefix":"10.23938","volume":"49","author":[{"given":"Mateo","family":"Cacho Uzal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3811-2118","authenticated-orcid":false,"given":"Juan","family":"Cueva Ares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fe","family":"Lopez-Juiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7928-6050","authenticated-orcid":false,"given":"Francisco","family":"Reyes Sant\u00edas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10024","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref0","unstructured":"(1) Ley 15\/1997 de 25 de abril, sobre la habilitaci\u00f3n de nuevas formas de gesti\u00f3n del Sistema Nacional de Salud; 1997."},{"key":"ref1","unstructured":"(2) Nieto A. Las fundaciones de inter\u00e9s gallego. Regulaci\u00f3n y Juicio Cr\u00edtico. Revista Jur\u00eddica Gallega 2001;30:337."},{"key":"ref2","unstructured":"(3) Alfonso Mellado CL. La reversi\u00f3n a la gesti\u00f3n directa de servicios p\u00fablicos: problemas laborales. El Cronista del Estado Social y Democr\u00e1tico de Derecho 2017;69."},{"key":"ref3","unstructured":"(4) Real Decreto Legislativo 2\/2015, de 23 de octubre, por el que se aprueba el texto refundido de la Ley del Estatuto de los Trabajadores. BOE 255, de 24 de octubre de 2015."},{"key":"ref4","unstructured":"(5) Real Decreto Legislativo 5\/2015, de 30 de octubre, por el que se aprueba el texto refundido de la Ley del Estatuto B\u00e1sico del Empleado P\u00fablico. BOE 261, de 31 de octubre de 2015."},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"(6) P\u00e9rez-Romero C, Ortega-D\u00edaz MI, Oca\u00f1a-Riola R, Mart\u00edn-Mart\u00edn JJ. An\u00e1lisis de la eficiencia t\u00e9cnica en los hospitales del Sistema Nacional de Salud espa\u00f1ol. Gac Sanit 2017;31(2):108-115. https:\/\/doi.org\/10.1016\/j.gaceta.2016.10.007","DOI":"10.1016\/j.gaceta.2016.10.007"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"(7) P\u00e9rez-Romero C, Ortega-D\u00edaz MI, Oca\u00f1a-Riola R, Mart\u00edn-Mart\u00edn JJ. An\u00e1lisis multinivel de la eficiencia t\u00e9cnica de los hospitales del Sistema Nacional de Salud espa\u00f1ol por tipo de propiedad y gesti\u00f3n. Gac Sanit 2019;33(4):325-332. https:\/\/doi.org\/10.1016\/j.gaceta.2018.02.005","DOI":"10.1016\/j.gaceta.2018.02.005"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"(8) Oca\u00f1a-Riola R, P\u00e9rez-Romero C, Ortega-D\u00edaz MI, Mart\u00edn-Mart\u00edn JJ. Multilevel zero-one inflated beta regression model for the analysis of the relationship between exogenous health variables and technical efficiency in the Spanish National Health System hospitals. Int J Environ Res Public Health 2021;18(19):10166. https:\/\/doi.org\/10.3390\/ijerph181910166","DOI":"10.3390\/ijerph181910166"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"(9) Ortega-D\u00edaz MI, Oca\u00f1a-Riola R, P\u00e9rez-Romero C, Mart\u00edn-Mart\u00edn JJ. Multilevel analysis of the relationship between ownership structure and technical efficiency frontier in the Spanish National Health System hospitals. Int J Environ Res Public Health 2020;17(16):5905. https:\/\/doi.org\/10.3390\/ijerph17165905","DOI":"10.3390\/ijerph17165905"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"(10) Belloni G, Monod S, Poroes C, B\u00fchler N, Avendano M, Wernli D. Health systems governance, shocks and resilience: a scoping review of key concepts and theories. BMJ Glob Health 2025;10(6):e017358. https:\/\/doi.org\/10.1136\/bmjgh-2024-017358","DOI":"10.1136\/bmjgh-2024-017358"},{"key":"ref10","unstructured":"(11) Ort\u00fan G, L\u00f3pez G, Puig J, Sab\u00e9s R. El sistema de financiaci\u00f3n capitativo: posibilidades y limitaciones. Centre de Recerca en Econom\u00eda i Salut, Universitat Pompeu Fabra, 2001."},{"key":"ref11","unstructured":"(12) Ribera Salud Grupo. Memoria de Gesti\u00f3n 2014-2015-2016. Hospital Universitario de La Ribera; 2017."},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"(13) P\u00e9rez-Romero C, Ortega-D\u00edaz MI, Oca\u00f1a-Riola R, Mart\u00edn-Mart\u00edn JJ. An\u00e1lisis de la eficiencia t\u00e9cnica en los hospitales del Sistema Nacional de Salud espa\u00f1ol. Gac Sanit 2017;31(2):108-115. https:\/\/doi.org\/10.1016\/j.gaceta.2016.10.007","DOI":"10.1016\/j.gaceta.2016.10.007"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"(14) O'Neill L, Rauner M, Heidenberger K, Kraus M. A cross-national comparison and taxonomy of DEA-based hospital efficiency studies. Socio-Economic Planning Sciences 2008;42(3):158-189. https:\/\/doi.org\/10.1016\/j.seps.2007.03.001","DOI":"10.1016\/j.seps.2007.03.001"},{"key":"ref14","unstructured":"(15) Manual de definiciones estad\u00edsticas de centros sanitarios especializados con internamiento. https:\/\/www.msssi.gob.es\/estadEstudios\/estadisticas\/docs\/TablasSIAE2015\/Definiciones2009.pdf"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"(16) Afonso A, St Aubyn M. Relative efficiency of health provision: A DEA approach with nondiscretionary inputs. Applied Economics Letters. 2011;18(15):1427-1430. https:\/\/doi.org\/10.1080\/13504851.2010.541149","DOI":"10.1080\/13504851.2010.541149"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"(17) Hollingsworth B. The measurement of efficiency and productivity of health care delivery. Health Econ 2008;17(10):1107-1128. https:\/\/doi.org\/10.1002\/hec.1391","DOI":"10.1002\/hec.1391"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"(18) Simar L, Wilson PW. Estimation and inference in two-stage, semi-parametric models of production processes. J Econom 2007;136(1):31-64. https:\/\/doi.org\/10.1016\/j.jeconom.2005.07.009","DOI":"10.1016\/j.jeconom.2005.07.009"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"(19) Bogetoft P, Otto L. Benchmarking with DEA, SFA, and R. New York: Springer; 2011.","DOI":"10.1007\/978-1-4419-7961-2"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"(20) Cheng TC, Haisken-DeNew JP, Yong J. Cream skimming and hospital transfers in a mixed public-private system. Soc Sci Med 2015;132:156-164. https:\/\/doi.org\/10.1016\/j.socscimed.2015.03.035","DOI":"10.1016\/j.socscimed.2015.03.035"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"(21) Cueva Ares J, Cacho Uzal M, Lopez-Juiz F, Reyes-Sant\u00edas F. \u00bfNuevos modelos de gesti\u00f3n o gesti\u00f3n tradicional de los hospitales? Reversi\u00f3n de un hospital-fundaci\u00f3n en una eurorregi\u00f3n. An Sist Sanit Navar 2024;47(3):e1100. https:\/\/doi.org\/10.23938\/ASSN.1100","DOI":"10.23938\/ASSN.1100"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"(22) Pollock AM, Dunnigan M, Gaffney D, Macfarlane A, Majeed FA. What happens when the private sector plans hospital services for the NHS: Three case studies under the private finance initiative. BMJ 1997;314(7089):1266-1271. https:\/\/doi.org\/10.1136\/bmj.314.7089.1266","DOI":"10.1136\/bmj.314.7089.1266"},{"key":"ref22","unstructured":"(23) Sindicatura de Comptes. Auditoria operativa de la concessi\u00f3 de l'assist\u00e8ncia sanit\u00e0ria integral en el Departament de Salut de Torrevella. Exercicis 2003-2016. Pa\u00eds Valenci\u00e1. Valencia; 2018."},{"key":"ref23","unstructured":"(24) Sindicatura de Comptes. Auditoria operativa de la concessi\u00f3 de l'assist\u00e8ncia sanit\u00e0ria integral en el Departament de Salut de Manises. Exercicis 2009-2015. Pa\u00eds Valenci\u00e1. Valencia; 2017."},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"(25) Barasa E, Kazungu J, Orangi S, Kabia E, Ogero M, Kasera K. Indirect health effects of the COVID-19 pandemic in Kenya: a mixed methods assessment. BMJ Health Serv Res 2021;21(1):740. https:\/\/doi.org\/10.1186\/s12913-021-06726-4","DOI":"10.1186\/s12913-021-06726-4"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"(26) Pecoraro F, Clemente F, Luzi D. The efficiency in the ordinary hospital bed management in Italy: An in-depth analysis of intensive care unit in the areas affected by COVID-19 before the outbreak. PLoS One 2020;15(9):e0239249. https:\/\/doi.org\/10.1371\/journal.pone.0239249","DOI":"10.1371\/journal.pone.0239249"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"(27) Mitakos A, Mpogiatzidis P. Operational efficiency of public hospitals in Greece during the COVID-19 pandemic: A comparative analysis using DEA and AHP models. J Mark Access Health Policy 2024;12(4):388-402. https:\/\/doi.org\/10.3390\/jmahp12040030","DOI":"10.3390\/jmahp12040030"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"(28) Franco Miguel JL, Fullana Belda C, R\u00faa Vieites A. Analysis of the technical efficiency of the forms of hospital management based on public-private collaboration of the Madrid Health Service, as compared with traditional management. Int J Health Plann Manage 2019;34(1):414-442. https:\/\/doi.org\/10.1002\/hpm.2678","DOI":"10.1002\/hpm.2678"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"(29) G\u00f3mez-Gallego JC, G\u00f3mez-Gallego M, Garc\u00eda-Garc\u00eda JF, Faura-Martinez U. Evaluation of the efficiency of European health systems using fuzzy data envelopment analysis. Healthcare 2021:9(10):1270. https:\/\/doi.org\/10.3390\/healthcare9101270","DOI":"10.3390\/healthcare9101270"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"(30) Baudier P, Kondrateva G, Ammi C, Chang V, Schiavone F. Digital transformation of healthcare during the COVID-19 pandemic: Patients' teleconsultation acceptance and trusting beliefs. Technovation. 2023;120:102547. https:\/\/doi.org\/10.1016\/j.technovation.2022.102547","DOI":"10.1016\/j.technovation.2022.102547"}],"container-title":["Anales del Sistema Sanitario de Navarra"],"original-title":[],"link":[{"URL":"https:\/\/recyt.fecyt.es\/index.php\/ASSN\/article\/download\/116090\/87722","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/recyt.fecyt.es\/index.php\/ASSN\/article\/download\/116090\/87722","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:23:37Z","timestamp":1782300217000},"score":1,"resource":{"primary":{"URL":"https:\/\/recyt.fecyt.es\/index.php\/ASSN\/article\/view\/116090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,10]]}},"URL":"https:\/\/doi.org\/10.23938\/assn.1162","relation":{},"ISSN":["2340-3527","1137-6627"],"issn-type":[{"value":"2340-3527","type":"electronic"},{"value":"1137-6627","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,29]]}}}