Does industry change affect strategic, governance, and financial configurations of private hospital providers? A survey of Italian private healthcare organizations.

The Italian National Health Service (I-NHS) has been affected by a deep evolution of its institutional systems, due to the pursuit of economic sustainability. In the last decade, 10 Regions adopted Health Cutback Plans. The other 10 Regions started processes of grip-back of health policies with the aim of rebalancing the system's hospital-centered vision. Under these circumstances, private hospitals have been pushed by financial and regulatory pressures towards processes of industry concentration (Cuccurullo and Pennarola, 2017). Italian private hospitals have 30.2% of the beds of the overall offer (Lega et al., 2018). Their ownership is private, but they operate in a regulated sector and are subject to the dynamics and rules of the public sector (Carbone 2013). Moreover, they generally are SMEs (only 12% exceed 200 beds) with concentrated ownership (typically family business) and face the industry transition with difficulties. Recently, Italian scholars pay attention to private hospitals, especially in terms of firm size and scope through qualitative methods, such as case studies. The financial and governance configurations of private hospitals are little explored. Our purpose is to bridge the gap, mapping statically and dynamically the configurational archetypes (Sarto et al., 2014). Methodologically, we have collected financial data of all Italian private hospitals (Ateco 86.10.10) and built a dataset (drop-off criteria: 1-the legal form other than SpA and Srl; 2- the activity other than hospitalization for acute cases; 3- lack of data) with data from 2008, 2012 and 2016. We have analyzed the dataset through factorial analysis and clustering techniques to trace the profile of private hospitals in their evolution from 2008 to 2016. The level of analysis is twofold: Region (the I-NHS is decentralized) and hospital. Findings allow us to understand the intra-industry dissimilarities, with useful implications for policymakers, management, consultants and analysts, who play a professional role in the industry concentration process (Cuccurullo et al, 2016). Our paper ends with a methodological proposal for using statistical analysis of financial data for SMEs with concentrated ownership.