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"Privatization - organization "
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Changes in hospital efficiency after privatization
We investigated the effects of privatization on hospital efficiency in Germany. To do so, we obtained bootstrapped data envelopment analysis (DEA) efficiency scores in the first stage of our analysis and subsequently employed a difference-in-difference matching approach within a panel regression framework. Our findings show that conversions from public to private for-profit status were associated with an increase in efficiency of between 2.9 and 4.9%. We defined four alternative post-privatization periods and found that the increase in efficiency after a conversion to private for-profit status appeared to be permanent. We also observed an increase in efficiency for the first three years after hospitals were converted to private non-profit status, but our estimations suggest that this effect was rather transitory. Our findings also show that the efficiency gains after a conversion to private for-profit status were achieved through substantial decreases in staffing ratios in all analyzed staff categories with the exception of physicians and administrative staff. It was also striking that the efficiency gains of hospitals converted to for-profit status were significantly lower in the diagnosis-related groups (DRG) era than in the pre-DRG era. Altogether, our results suggest that converting hospitals to private for-profit status may be an effective way to ensure the scarce resources in the hospital sector are used more efficiently.
Journal Article
Fears over plan to privatise India's district hospitals
The proposal, it said, violates the spirit of universal health coverage, and India's National Health Policy 2017, which promised free drugs, diagnostics, and care for all in public hospitals. K Srinath Reddy, president of the Public Health Foundation of India, says the plan will disconnect the government-run primary health-care services from secondary health care, disrupting a vital link in the universal health coverage pathway. Jha stressed the need to improve both state-run and existing private sector hospitals by developing robust referral pathways, conducting quality audits, incentivising improvements in the efficiency and quality of care, and strengthening the capacity of the public sector to effectively contract with and regulate the private sector.
Journal Article
Patient choice and private provision decreased public provision and increased inequalities in Scotland
This is the first research to examine how the policy of patient choice and commercial contracting where NHS funds are given to private providers to tackle waiting times, impacted on direct NHS provision and treatment inequalities.
An ecological study of NHS funded elective primary hip arthroplasties in Scotland using routinely collected inpatient data 1 April 1993-31 March 2013.
An increased use of private sector provision by NHS Boards was associated with a significant decrease in direct NHS provision in 2008/09 (P < 0.01) and with widening inequalities by age and socio-economic deprivation. National treatment rate fell from 143.8 (140.3, 147.3) per 100 000 in 2006/07 to 137.8 (134.4, 141.2) per 100 000 in 2007/08. By 2012/13, territorial NHS Boards had not recovered 2006/07 levels of provision; this was most marked for NHS Boards with the greatest use of private sector, namely Fife, Grampian and Lothian. Patients aged 85 years and over or living in the more deprived areas of Scotland appear to have been disadvantaged since the onset of patient choice in 2002.
NHS funding of private sector provision for elective hip arthroplasty was associated with a decrease in public provision and may have contributed to an increase in age and socio-economic inequalities in treatment rates.
Journal Article
Is the quality of primary healthcare services influenced by the healthcare centre’s type of ownership?—An observational study of patient perceived quality, prescription rates and follow-up routines in privately and publicly owned primary care centres
Background
Primary healthcare in Sweden has undergone comprehensive reforms, including freedom of choice regarding provider, freedom of establishment and increased privatisation aiming to meet demands for quality and availability. In this system privately and publicly owned primary care centres with different business models (for-profit vs non-profit) coexist and compete for patients, which makes it important to study whether or not the type of ownership influences the quality of the primary healthcare services.
Methods
In this retrospective observational study (April 2011 to January 2014) the patient perceived quality, the use of antibiotics and benzodiazepine derivatives, and the follow-up routines of certain chronic diseases were analysed for all primary care centres in Region Västra Götaland. The outcome measures were compared on a group level between privately owned (
n
= 86) and publicly owned (
n
= 114) primary care centres (PCC).
Results
In comparison with the group of publicly owned PCCs, the group of privately owned PCCs were characterized by: a smaller, but continuously growing share of the population served (from 32 to 36 %); smaller PCC population sizes (avg. 5932 vs. 9432 individuals); a higher fraction of PCCs located in urban areas (57 % vs 35 %); a higher fraction of listed citizens in working age (62 % vs. 56 %) and belonging to the second most affluent socioeconomic quintile (26 % vs. 14 %); higher perceived patient quality (82.4 vs. 79.6 points); higher use of antibiotics (6.0 vs. 5.1 prescriptions per 100 individuals in a quarter); lower use of benzodiazepines (DDD per 100 patients/month) for 20–74 year olds (278 vs. 306) and >74 year olds (1744 vs.1791); lower rates for follow-ups of chronic diseases (71.2 % vs 74.6 %). While antibiotic use decreased, the use of benzodiazepines increased for both groups over time.
Conclusions
The findings of this study cannot unambiguously answer the question of whether or not the quality is influenced by the healthcare centre’s type of ownership. It can be questioned whether the reform created conditions that encouraged quality improvements. Tendencies of an (unintended) unequal distribution of the population between the two groups with disparities in age, socio-economy and geography might lead to unpredictable effects. Further studies are necessary for evidence-informed policy-making.
Journal Article
SWEDEN—RECENT CHANGES IN WELFARE STATE ARRANGEMENTS
The Swedish welfare state, once developed to create a new society based on social equality and universal rights, has taken on a partly new direction. Extensive choice reforms have been implemented in social services and an increasing proportion of tax-funded social services, including child day care, primary and secondary schools, health care, and care of the elderly, is provided by private entrepreneurs, although funded by taxes. Private equity firms have gained considerable profits from the welfare services. The changes have taken place over a 20-year period, but at an accelerated pace in the last decade. Sweden previously had very generous sickness and unemployment insurance, in terms of both duration and benefit levels, but is falling behind in terms of generosity, as indicated by increasing levels of relative poverty among those who depend on benefits and transfers. Increasing income inequality over the past 20 years further adds to increasing the gaps between population groups. In some respects, Sweden is becoming similar to other Organisation for Economic Co-operation and Development countries. The article describes some of the changes that have occurred. However, there is still widespread popular support for the publicly provided welfare state services.
Journal Article
WHY PUBLIC HEALTH SERVICES? EXPERIENCES FROM PROFIT-DRIVEN HEALTH CARE REFORMS IN SWEDEN
Market-oriented health care reforms have been implemented in the tax-financed Swedish health care system from 1990 to 2013. The first phase of these reforms was the introduction of new public management systems, where public health centers and public hospitals were to act as private firms in an internal health care market. A second phase saw an increase of tax-financed private for-profit providers. A third phase can now be envisaged with increased private financing of essential health services. The main evidence-based effects of these markets and profit-driven reforms can be summarized as follows: efficiency is typically reduced but rarely increased; profit and tax evasion are a drain on resources for health care; geographical and social inequities are widened while the number of tax-financed providers increases; patients with major multi-health problems are often given lower priority than patients with minor health problems; opportunities to control the quality of care are reduced; tax-financed private for-profit providers facilitate increased private financing; and market forces and commercial interests undermine the power of democratic institutions. Policy options to promote further development of a nonprofit health care system are highlighted.
Journal Article
Criminal (In)Justice in the City and Its Associated Health Consequences
The American system of prisons and prisoners—described by its critics as the prison–industrial complex—has grown rapidly since 1970. Increasingly punitive sentencing guidelines and the privatization of prison-related industries and services account for much of this growth. Those who enter and leave this system are increasingly Black or Latino, poorly educated, lacking vocational skills, struggling with drugs and alcohol, and disabled. Few correctional facilities mitigate the educational and/or skills deficiencies of their inmates, and most inmates will return home to communities that are ill equipped to house or rehabilitate them. A more humanistic and community-centered approach to incarceration and rehabilitation may yield more beneficial results for individuals, communities, and, ultimately, society.
Journal Article
With Great Power Comes Great Responsibility
The English National Health Service (NHS) has suffered from a democratic deficit since its inception. Democratic accountability was to be through ministers to Parliament, but ministerial control over and responsibility for the NHS were regarded as myths. Reorganizations and management and market reforms, in the neoliberal era, have centralized power within the NHS. However, successive governments have sought to reduce their responsibility for health care through institutional depoliticization, to shift blame, facilitated through legal changes. New Labour’s creation of the National Institute for Clinical Excellence (NICE) and Monitor were somewhat successful in reducing ministerial culpability regarding health technology regulation and foundation trusts, respectively. The Conservative-Liberal Democrat coalition created NHS England to reduce ministerial culpability for health care more generally. This is pertinent as the NHS is currently being undermined by inadequate funding and privatization. However, the public has not shifted from blaming the government to blaming NHS England. This indicates limits to the capacity of law to legitimize changes to social relations. While market reforms were justified on the basis of empowering patients, I argue that addressing the democratic deficit is a preferable means of achieving this goal.
Journal Article