©
Tempura, Getty Images
The researchers carried out a meta-analysis based on evidence from 13 longitudinal studies, covering a range of high-income countries. Each study assessed quality of healthcare measures for patients before and after health service privatisation, at either the hospital or regional level. The studies included measured indicators of care quality which included staffing levels, patient mix by insurance type, the number of services provided, workload for doctors, and health outcomes for patients such as avoidable hospitalisations.
Key findings:
- Increases in privatisation generally corresponded with worse quality of care, with no studies included in the review finding unequivocally positive effects on health outcomes.
- Hospitals converting from public to private ownership status tended to make higher profits. This was mainly achieved by reducing staff levels and reducing the proportion of patients with limited health insurance coverage.
- Privatisation generally corresponded with fewer cleaning staff employed per patient, and higher rates of patient infections.
- In some studies, higher levels of hospital privatisation corresponded with higher rates of avoidable deaths.
- However, in some cases (e.g. Croatia), privatisation led to some benefits for patient access, through more precise appointments and new means of care delivery, such as out-of-hours telephone calls.
According to the researchers, the results challenge the theory that privatisation can improve the quality of healthcare through increased market competition, and by enabling a more flexible and patient-centred approach.