Can Questions of the Privatization and Corporatization, and the Autonomy and Accountability of Public Hospitals, Ever be Resolved?

Abstract

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.

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

“…As healthcare in European countries in the recent years has become to some extent more private, studies have been carried out to evaluate the effects [ 47 ]. However, a recent review stated that the evidence for recurring privatisation questions is weak and mixed [ 48 ]. The public-private mix in Swedish primary healthcare has changed substantially with consequences difficult to predict while the lack of data and neglect of research in this field have hindered informed policy-making [ 49 ].…”

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“…Previous studies have shown that corporate standardisation of issues such as clinical guidelines can help to secure improvement, and that common facility standardisation can also be beneficial, though standardising administration alone is not sufficient to increase care quality. 26,27 Having a large number of practices within the organisation enabled Primer to develop common policies that could be widely implemented. Like other larger firms, 28 Primer appeared able to cope better with standardisation and regulation than small enterprises, the company having the advantages of added managerial capacity with central leadership and management by concentrating resources in its head office, and relieving front-line GPs of administrative duties.…”

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