Perceived Quality and Users' Satisfaction with Public-Private Partnerships in Health Sector.

In Portugal, the government has accepted private management within public hospitals since 1996. The objectives of the state were to ensure more efficiency in resource management and maintain or increase the service quality provided to the users. Four public hospitals have been managed with a public-private partnership (PPP) approach. This study aimed to empirically analyse the degree of satisfaction of the Portuguese population regarding the service quality provided by PPP and Public Management Hospitals (PMH) within a structural equation model, and verify if people's literacy level, age, education, and income moderate their opinions. The study used 2077 valid questionnaire responses applied in the four regions served by the eight hospitals. The results show that the users of the PPP hospitals are more satisfied than those from PMH with statistical significance. Literacy level moderates the relationship between perceived quality and users' satisfaction, and education moderates the same relationship only in the context of PPP hospitals. More educated people with a high literacy level are more demanding, both regarding PPP and PMH hospitals. Nevertheless, the results are very beneficial to the PPP model; thus, improved decision-making regarding contract renewal might help policymakers consider the findings of this paper.