Public Hospital Governance for Value Creation: A Structured Comparative Review of Patient Satisfaction, Good Governance, Revenue Sustainability, and Quality of Care

Public hospitals are expected to protect universal access while improving patient experience, clinical outcomes, and financial resilience. These objectives are often treated as competing priorities, and revenue generation is sometimes pursued through activity expansion or patient charges that can undermine equity and quality. This structured comparative review asks which governance and financing arrangements can align the four objectives. A purposive sample of seven health-system settings—Sweden and Denmark (Nordic), Germany and the Netherlands (continental Europe), Japan, Türkiye, and Malaysia—was examined using peer-reviewed studies and institutional reports published mainly between ۲۰۱۰ and July ۲۰۲۶. Evidence was coded against five dimensions: hospital autonomy, accountability, provider payment and revenue retention, quality governance, and patient participation. The comparison shows that no single ownership form or payment method is sufficient. Stronger performers combine bounded managerial autonomy with competent boards, strategic purchasing, transparent performance data, patient-reported measures, and workforce capability. Activity-based payment and commercial service lines can increase revenue, but without budget, volume, equity, and quality guardrails they create overprovision, selection, and cost-shifting risks. The review proposes the GOVALUE-PH framework: governed autonomy; blended, risk-adjusted purchasing; board-level quality and financial accountability; patient and staff voice; and a reinvestment rule for retained surpluses. The model treats revenue as a means to public value rather than an independent endpoint. Its practical contribution is a balanced scorecard and staged implementation logic for public hospitals seeking simultaneous improvements in satisfaction, governance, sustainability, and treatment quality.

کلیدواژه ها:

Public hospitals ، Hospital governance ، Patient satisfaction ، Quality of care ، Strategic purchasing