Assessing the Quality of Public Services: Does Hospital Competition Crowd Out the For-Profit Quality Gap?

Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study of NHS privatisation

“…We combined our random error simulation (figure 3) with a specification curve (appendix pp [16][17][18]. All possible specifications reported similar findings, with positive associations between outsourcing and treatable mortality.…”

“…The results from the covariate balancing models were robust to model specification, including full matching, choice of covariates, and removing any individual CCG from the data (see the appendix pp [14][15][16][17][18][19][20].…”

“…To account for potential bias in the main result from the choice of covariates in the model, we present a specification curve in the appendix that is combined with the random error loops (pp [16][17]. Finally, we sequentially dropped each CCG from our fixed-effects model to test whether any individual CCG was driving a substantial amount of the average effect size (appendix pp [14][15].…”

“…One theory is that costcutting behaviours by for-profit providers mean that having more, and inferior, services provided by for-profit providers will lead to worse health-care quality and worse health outcomes. 16 Another key dynamic is the different case-mixes often observed between for-profit and public providers-a result of so-called cream-skimming and concentrating the most complicated cases with public providers, which have no extra staff or funding to compensate. 17 However, evidence of the impact of so-called creeping privatisation in general, and in the NHS in England in particular, remains uncertain.…”