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Privatisation in health care: concepts, motives and policies



Over the last decade privatisation has been used frequently as a policy instrument to reduce the financial burden of the public sector. In most countries there is a mix of public and private interests in health care. Because of this, privatisation is an important issue in health care policy analysis. In this article we deal with different concepts and motives for privatisation in general. We will distinguish various types of privatisation and show how these can be applied to changes in health care policy. As far as the latter is concerned we will use Dutch experiences. In the analysis we emphasise especially the effects of privatisation in health care on the private non-profit organizations.
... Many countries such as Germany, United Kingdom, and Netherlands have paved way for the private sector because of the liberal policies which have encouraged the private sector to strengthen the health system. [5] In these countries, the policies of the world bank and IMF are the reasons to foster the growth of the private sector. In a nutshell, we can say that when the private sector will work in close coordination with the public sector, it can put the end to the unending demand and expectations of the public. ...
... A simpler explanation for the uprising of the private sector could be explained through the inability of the public sector to provide desirable comprehensive healthcare to their people, unmet needs of the community population even after receiving the services provided through the public sector, increased demand and over expectation of the people from the public sector, and low Government expenditure on health as revealed by per cent GDP. Many countries like Germany, United Kingdom and Netherlands have paved way for the private sector because of the liberal policies which have encouraged the private sector to strengthen the health system [4]. In these countries, the policies of the world bank and IMF are the reasons to foster the growth of the private sector. ...
... Second, there has been a related trend towards the privatisation of health care as a policy instrument to relieve perceived pressures on public finances by reducing the role of the state (Janssen and van der Made 1990). This has been enacted through the selling off of health care facilities to private investors (e.g. ...
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Until the early twenty-first century, there was a virtual absence of health as a subject of inquiry in the field of international political economy (IPE). However, in recent years health has become one of the key emerging issue in the study of contemporary IPE. In this chapter we set out the core themes that define this growing field of scholarship. We draw upon the existing literature, from the IPE and health fields, to illustrate these themes including our own research on the IPE of tobacco control. We conclude by assessing the current state of IPE and health scholarship, and potential future directions for strengthening research.
... Den Hoed (1986) specifies three types of privatisation: complete termination of public tasks (termination), contracting out of public tasks (contracting out) and independent performance of public tasks (self governance). Hans Maarse (2006) further explains: termination means the government reduces the scope of public intervention, the tasks and responsibilities that were formerly defined as a public responsibility are shifted to the private sector; as the case of contracting out, the government does not reduce the scope of public intervention, retains its political responsibility, but contracts with private agents to accomplish public task; Richard Janssen and Jan van der Made (1990) add that in self governance, responsibility and performance remain public, but with more freedom in the performance of its tasks. Richard Janssen and Jan van der Made (1990) employ these three types of privatisation with the three aspects-service provision, financing, and policies, form a matrix to analyze the health care privatisation in Netherlands (See Table 1). ...
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Abstract The recent COVID-19 emergency has shown how universal healthcare and social security are indispensable to save lives, preserve human dignity and make economies resilient. The global lockdown, though, prompted a massive supply shock, which is now causing a new economic depression, different from any other recession in living memory. The Global South is being affected the most, with the virus wrecking communities and their economies. A rights-based approach to fiscal and economic recovery can be the answer. Indeed, partly as a consequence of the human suffering wrought by the 2008’s global financial crisis, human rights scholars and practitioners have developed a wide range of policy options to build inclusive, sustainable economic recovery. This article has two aims. First, it will review the normative foundation of the rights-based approach to economic recovery, including most recent developments, open debates as well as its strengths and weaknesses. Second, this work suggests that too little attention is paid to economic pluralism in such a framework. After briefly summarising what economic pluralism is, it will be argued why it is an invaluable tool in advancing rights-based recovery and overcoming the unnecessary Manichean opposition between economics and human rights. Overall, this work seeks to advance the academic discourse on a rights-based framework to economic recovery, as to place people at the centre amid the COVID-19 recession. Keywords: human rights budgeting, economic, social and cultural rights, economic pluralism, economics and human rights, COVID-19.
Although there is a long-standing international debate concerning the privatization and corporatization of health services, there has been relatively little systematic analysis of the ways these types of reform manifest. We examine the impact of privatization and corporatization on public hospitals, and in particular on hospitals' autonomy and accountability, with two aims: to uncover the key themes in the literature, and to consider implementation issues. The review of 2,319 articles was conducted using content analysis and a discussion of selected key issues. Several major themes appear in the privatization and corporatization literature, including their use as tools in health systems reform, and the role of governments in sponsoring the processes. We show that much of the underlying argument is ideological rather than evidence based. Those who promote versions of privatization or corporatization claim that decreased government involvement in the management of hospitals leads inter alia to benefits such as greater efficiency, better quality services, and increased choice for patients. Those who argue against say that increased privatization leads to deleterious outcomes such as decreased equity, compromised efficiency and poorer quality of care. The evidence is often weak and at times conflicting. Privatization and corporatization are difficult to implement, and at best produce mixed results, and their impact seems to depend more on the motivation of the evaluator than the standard of the results. These debates are of a type that is to a large extent only resolvable ideologically.
This paper analyzes the effects of time prices on the demand for general practitioner (GP) services. Where data on earnings per unit of time was not available, an alternative method was used to impute the value of time. Separate elasticities were estimated using interactive dummy variables for individual employment status. Furthermore, a distinction was made between patient-initiated and physician-initiated visits to a GP. The results show that the probability of a patient-initiated visit is negatively influenced by the time required, for 4 of the 6 employment status categories defined. For a subsample, time was valued on the basis of earnings per time unit. The resulting time price was found to have a significant negative impact on the probability of a patient-initiated visit to a GP. However neither time nor time prices have any effect on the probability of a physician-initiated visit. It can therefore be concluded that time prices are a relevant factor in the determination of demand for GP services, particularly if it is the patient who is making the decision. Ignoring time prices could result in the mis-specification of demand equations, obtaining biased results from statistical analyses and wrongly assessing policy implications.
The question that is dealt with in this article concerns the reasons for collectivisation of health insurance. This is not the same as collectivisation of health care. The The theoretical model of Usher, with the assumption that a commodity will be socialized if and only if a majority can be found in favour of socialization, appears relevant for the explanation of the origin and growth of social health insurance. Empirical evidence for the Netherlands, where reforms in the social health insurance are going on and common sense suggests that the taste factor is not very relevant, because preferences do not diverge very much among voters. This makes the income factor dominant. Since a majority will profit from socialization of health insurance, there is a strong tendency for collectivisation.
We discuss some of the challenges facing hospitals in developed nations, with special attention to the need to monitor and evaluate hospital performance. In particular, there is a need for quality indicators that measure the effects of treatment, and are risk-adjusted, so that valid comparisons of outcomes can be made across hospitals that treat different types of patients. Until recently, only very crude quality indicators have been available for comparing the performance of different hospitals. We describe three risk-adjusted indices for comparing the outcomes of hospital care, focusing on the construction and validation of these measures. We discuss the uses of these tools for identifying problems and for monitoring outcomes of care within a hospital, including screening medical records for peer review, identifying variations in outcomes across various subgroups of physicians, and comparing changes in outcomes following various changes in the delivery system. Possible applications at the regional, national and international levels are then discussed, with special emphasis on the use of these tools for measuring the size of the gap between the efficacy of a technology, as determined through randomized controlled trials under stringent protocols, and the effectiveness of the same technology once it is exported, and then used under true practice conditions in another country.
The municipal reformmovement of the progres- sive era succeeded throughout America in establishing local government monopoly in the provision of urban services. Competitive markets in such services as fire-fighting, street lighting, refuse removal, transit, and even policing, gave way to municipal bureaus and departments. That these reforms have resulted in unresponsive and inefficient service delivery systems should occasion no great surprise. Civil service reforms and now the advent of public employee unions have exacerbated the situation by vesting public employees with monopoly power. In recent years the monetary costs of municipally-provided services have increased more rapidly than costs in any sector of the private economy (save construction), yet the quality of these services has not perceptibly improved. The quality of many services, notably education, has deteriorated. With municipal taxes soaring, the majority of city dwellers feel - not without justification - that they are not getting their money's worth.1'1
Privatisering buiten de politiek
  • Den Hoed
Den Hoed, P.. Privatiserhrg buiten de politiek. In: Beleid en Maatschappij, 2 (1986) 57-58.
Publieke sector en economische orde, Wolters Noordhof, Groningen. 1988, p. 365. Change assured. In: Changing health cam in the Netherlands
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Wolfson, D.J., Publieke sector en economische orde, Wolters Noordhof, Groningen. 1988, p. 365. Change assured. In: Changing health cam in the Netherlands. Rijswijk, 1988. pp. 63-90.
Non-profit firms in medical markets Privatisering en het probleem van de meespelende scheidsmchter
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  • H J Dt Ru
Pauly, V., Non-profit firms in medical markets. In: The American Economic Review, 77 (1987) 257-262 Dt Ru, H.J., Privatisering en het probleem van de meespelende scheidsmchter. In: Beleid en Maatschappij. 2 (1986) 5969.