Healthcare governance, ownership structure and performance of hospitals in Ghana

It is argued that healthcare governance should play an important role in the overall functioning and effective performance of hospitals. However, the literature is devoid of how healthcare governance influences the performance of hospitals in Africa and other developing countries. This study examines the effects of hospital boards and ownership structure on the performance of hospitals in Ghana. The study specifically examines the characteristics of hospital boards, ascertains whether the presence of a hospital board and ownership structure affect hospital performance, evaluates the effects of hospital board characteristics and ownership structure on hospital performance, and also investigates the interaction effects of hospital board characteristics and ownership on performance. Based on a sample of 132 hospitals, the study produces a number of results. First, the study indicates that 69% of the hospitals have a board in place. The results also show that all the mission hospitals have a board in place. Half of the public hospitals and 80% of the private hospitals also have a board. The hospitals with a board exhibit varying board characteristics. Using regression models, the results show that hospitals with a board demonstrate lower occupancy, higher discharge and deliver better quality healthcare. In terms of the effect of board characteristics on performance, smaller boards are associated with better health service quality and lower occupancy. Hospitals with greater proportion of outside board members assist management to be cost efficient and improve on their operations leading to higher discharge. The results also show that hospitals with greater representation of medical staff on the board perform better in terms of occupancy but are less cost efficient. Hospitals with CEO duality perform better in terms of efficiency. However, hospitals with separate positions for the CEO and chair perform better in terms of discharge and service quality. Additionally, the evidence suggests that boards with higher female representation deliver better quality of healthcare, resulting in higher discharge rate. Also, frequency of board meetings is associated with lower occupancy, higher discharge and improved health service quality. The results also show that mission-based and private hospitals perform better than public hospitals. Further, the results of the interaction effects suggest that mission-based and private hospitals with effective board governance exhibit better performance than public hospitals. This study makes a number of new and meaningful contributions to the extant literature and the findings support managerialism, stakeholder and resource dependency theories. The findings also have important implications for effective and efficient governance and management of hospitals.