Privatisation of government services in Australia: what is known about health and equity impacts.

BACKGROUND: Historically in Australia, all levels of government created collective wealth by owning and operating infrastructure, and managing natural assets, key public goods and essential services while being answerable to the public. This strong state tradition was challenged in the 1980s when privatisation became a widespread government approach globally. Privatisation involves displacing the public sector through modes of financing, ownership, management and product or service delivery. The Australian literature shows that negative effects from privatisation are not spread equitably, and the health and equity impacts appear to be under-researched. This narrative overview aims to address a gap in the literature by answering research questions on what evidence exists for positive and negative outcomes of privatisation; how well societal impacts are evaluated, and the implications for health and equity. METHODS: Database and grey literature were searched by keywords, with inclusion criteria of items limited to Australia, published between 1990 and 2022, relating to any industry or government sector, including an evaluative aspect, or identifying positive or negative aspects from privatisation, contracting out, or outsourcing. Thematic analysis was aided by NVivo qualitative data software and guided by an a-priori coding frame. RESULTS: No items explicitly reflected on the relationship between privatisation and health. Main themes identified were the public cost of privatisation, loss of government control and expertise, lack of accountability and transparency, constraints to accessing social determinants of health, and benefits accruing to the private sector. DISCUSSION: Our results supported the view that privatisation is more than asset-stripping the public sector. It is a comprehensive strategy for restructuring public services in the interests of capital, with privatisation therefore both a political and commercial determinant of health. There is growing discussion on the need for re-nationalisation of certain public assets, including by the Victorian government. CONCLUSION: Privatisation of public services is likely to have had an adverse impact on population health and contributed to the increase in inequities. This review suggests that there is little evidence for the benefits of privatisation, with a need for greater attention to political and commercial determinants of health in policy formation and in research.

Green financial investment and its influence on economic and environmental sustainability: does privatization matter?

Green financial investment and privatization have been widely used as policy tools to promote economic growth and efficiency in many countries. However, their effects on environmental sustainability have been less explored. This study utilizes autoregressive distributed lag (ARDL) and quantile autoregressive distributed lag (QARDL) techniques to explore the effects of green financial investment and privatization on economic and environmental performance in China. Using data from 1995 to 2021, we analyze the impact of green financial investment and privatization on economic performance, measured by GDP per capita, and environmental performance, measured by CO2 emissions based on green finance and privatization theories. Our findings reveal that green financial investment has a beneficial effect on both economic and environmental performance. On the other hand, privatization has a positive impact on long-term economic performance, while also having negative consequences on environmental performance. These findings can inform evidence-based policies and strategies that promote both economic and environmental performance.

Carbon emission reduction policy with privatization in an oligopoly model.

This study constructs a mixed oligopoly model that includes a public enterprise and two private enterprises. Game theory was adopted to explore the effects of carbon emission reduction policies. In addition, this study analyzes the optimal carbon emission trading prices and privatization decisions. The results show that the proportion of state-owned shares and the equity efficiency gap affect the equilibrium results for different carbon emission policies. Privatization increases the profits of public firms but does not necessarily increase social welfare. Different carbon emission reduction policies have different effects on the equilibrium results. Moreover, the emission reduction target is not completely consistent with the maximum social welfare target and should be comprehensively considered. The government can intervene by setting carbon emission trading prices and making privatization decisions. Full and partial privatization may be optimal decisions.

[Following the money: an analysis of financial transfers from the municipality of Rio de Janeiro, Brazil to social health organizations]. / Seguindo o dinheiro: análise dos repasses financeiros do Município do Rio de Janeiro, Brasil, para as organizações sociais de saúde.

This article analyzed the activity of Social Health Organizations (OSS) in the Brazilian Unified National Health System (SUS) and the use of management contracts and contract addenda as instruments of privatization. The article aimed to understand the processes that legitimize privatization, based on quantification of the amounts transferred through management contracts and contract addenda to organizations that signed contracts with the Rio de Janeiro Municipal Health Department, Rio de Janeiro, Brazil, from 2009 to 2018. A descriptive, exploratory, mixed-methods study was developed to analyze the amounts transferred to the OSS. The study used secondary public data available on the Health Department's websites and other official documents. A total of 268 documents were identified, 61 of which were contracts and 207 addenda, related to 15 institutions. The funds transferred to these organizations totaled BRL 15.94 billion (USD 2.9 billion). The OSS that received the most public funds was IABAS (Institute of Primary and Advanced Health Care), with a total of BRL 4.021 billion (USD 731 million). In 2014, Rio de Janeiro's total health budget was approximately BRL 4 billion (USD 727 million), of which BRL 2.5 billion (USD 455 million) was transferred to OSS, representing 62% of the municipal health budget. The data show that management contracts and contract addenda serve as instruments for privatization of the SUS. This privatization does not employ the conventional model but a functional and fluctuating one.

Este artigo analisou a atuação das Organizações Sociais de Saúde (OSS) no Sistema Único de Saúde (SUS) e o uso dos contratos de gestão e dos termos aditivos como instrumentos de privatização. O objetivo foi compreender os processos que legitimam a privatização, a partir da quantificação dos valores financeiros repassados por meio de contratos de gestão e termos aditivos para as organizações que firmaram contratos com a Secretaria Municipal de Saúde do Rio de Janeiro (SMS-RJ), Brasil, entre 2009 e 2018. Foi desenvolvido um estudo descritivo e exploratório com abordagem mista para analisar os valores repassados às OSS. Trabalhou-se com dados secundários públicos e disponíveis nos portais eletrônicos da SMS-RJ, além de outros documentos oficiais. Foram identificados 268 documentos, sendo 61 contratos e 207 aditivos, relacionados a 15 instituições. O volume financeiro total repassado a essas organizações foi de BRL 15,94 bilhões. A OSS IABAS (Instituto de Atenção Básica e Avançada à Saúde) foi a que mais recebeu recursos públicos, somando BRL 4,021 bilhões. Em 2014, o orçamento total da saúde do município do Rio de Janeiro foi de aproximadamente BRL 4 bilhões, sendo que desse montante BRL 2,5 bilhões foram repassados para as OSS, representando 62% do orçamento da saúde. Com base nos dados, podemos afirmar que os contratos de gestão e os termos aditivos são instrumentos de privatização do SUS. Essa privatização não se dá no modelo convencional, mas em um tipo funcional e flutuante.

Este artículo analizó la actuación de las Organizaciones Sociales de Salud (OSS) en el Sistema Único de Salud (SUS), así como el uso de los contratos de gestión y anexos como instrumentos de privatización. El objetivo fue comprender los procesos que legitiman la privatización, a partir de la cuantificación de los valores financieros transferidos mediante contratos de gestión y anexos a organizaciones que firmaron contratos con la Secretaría Municipal de Salud de Río de Janeiro (SMS-RJ), Brasil, entre 2009 y 2018. Se desarrolló un estudio descriptivo y exploratorio con un abordaje mixto para analizar los valores transferidos a las OSS. Se trabajó con datos secundarios públicos y disponibles en los portales electrónicos de la SMS-RJ, además de otros documentos oficiales. Se identificaron 268 documentos, siendo 61 contratos y 207 anexos, relacionados con 15 instituciones. El volumen financiero total transferido a esas organizaciones fue de BRL 15,94 mil millones. La OSS IABAS fue la que más recursos públicos recibió, sumando BRL 4,021 mil millones. En 2014, el presupuesto total de salud del municipio de Río de Janeiro fue de aproximadamente BRL 4 mil millones, siendo que de ese montante BRL 2,5 mil millones fueron transferidos a las OSS, representando un 62% del presupuesto de la salud. En base a estos datos, podemos afirmar que los contratos de gestión y los anexos son instrumentos de privatización del SUS. Esa privatización no se produce en el modelo convencional, sino en un tipo funcional y fluctuante.

Can ENGLAND'S National Health System Reforms Overcome the Neoliberal Legacy?

England's National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal "market" are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms.

Research on the economic impact of environmental tax under the background of state-owned enterprise shareholding reform in an open economic system.

In this paper, we construct a Stackelberg-Cournot tripartite game model and discuss the impact of tariff policy on the privatization of the state-owned enterprise, environmental tax, pollutant emission, and social welfare in an open economic system. We find that with the increase in tariff, the proportion of privatization of the state-owned enterprise increases, environmental tax falls, and environmental pollution alleviates. The relationship between social welfare and tariff is inverted U-shaped. A closed trade environment is most conducive to environmental protection, but the environmental tax at this time is very detrimental to social welfare. When social welfare is optimal, environmental damage is not the smallest.

O papel do Fies e do Prouni na privatização, mercantilização e financeirização da educação superior brasileira / El papel de Fies y Prouni en la privatización, marketing y financialización de la educación superior brasileñalos / The role of Fies and Prouni in the privatization, commodification and financialization of brazilian higher education

O FIES e o PROUNI são programas da política nacional de educação que têm como foco a expansão das vagas e o acesso ao ensino superior. Eles são direcionados ao setor privado e possibilitam o ingresso de estudantes em situação econômica mais vulneráveis. A despeito de se apresentarem como comprometidos com as alternativas de inclusão social, esses Programas vêm sendo determinantes para as relações de privatização, de mercantilização e de financeirização do ensino superior. Dada essa constatação, o artigo faz uma abordagem crítica dessas relações, através de uma pesquisa documental e bibliográfica. Dentre os resultados constam evidenciadas a preocupação com a regulamentação do setor, com a priorização da educação pela via privada, as implicações dos Programas para as transformações estruturais nas instituições públicas e para a qualidade do ensino superior.(AU)

FIES y PROUNI son programas de política educativa nacional que se enfocan en ampliar las vacantes y el acceso a la educación superior. Están dirigidos al sector privado y permiten la entrada de estudiantes en situaciones económicas más vulnerables. A pesar de presentarse como comprometidos con alternativas de inclusión social, estos programas han sido determinantes para las relaciones de privatización, mercantilización y financiarización de la educación superior. Ante este hallazgo, el artículo realiza una aproximación crítica a estas relaciones, a través de una investigación documental y bibliográfica. Entre los resultados se evidencia la preocupación con la regulación del sector, con la priorización de la educación por la vía privada, las implicaciones de los Programas para las transformaciones estructurales en las instituciones públicas y para la calidad de la educación superior.(AU)

FIES and PROUNI are national education policy programs that focus on expanding vacancies and access to higher education. They are aimed at the private sector and allow the entry of students in more vulnerable economic situations. Despite presenting themselves as committed to alternatives for social inclusion, these programs have been decisive for the relations of privatization, commodification and financialization of higher education. Given this finding, the article makes a critical approach to these relationships, through documental and bibliographic research. Among the results are evident the concern with the regulation of the sector, with the prioritization of education through the private route, the implications of the Programs for the structural transformations in public institutions and for the quality of higher education.(AU)

Privatising, liberalising and dividing a welfare state without affecting universality? Debunking the myths surrounding the rapid rise of private health insurance in Sweden.

The privatisation of provision and the emerging privatisation of funding, manifested in the rapid rise of private health insurance, are the most obvious signs that the universal, Swedish health system is gradually weakened. Meanwhile, the private welfare industry creates a neoliberal Newspeak where the burdening effects of the private insurance system on public healthcare are said to be unburdening, and where every step away from the principles of a universal welfare model is said to be in line with the principles of a universal welfare model. The language spoken by the private welfare industry spills over into authorities, journalists and scholars. In this article, I discuss, problematise and partially reject two research questions - Does VHI unburden the public health care system? and Are VHI holders less supportive of funding public health care? - where the authors fail to place development in the context of increased inequality and declining tax ratio, and where they use the welfare industry's definitions invented to blur the consequences of a parallel health system.

Privatization and geographic inequalities in the distribution and expansion of higher nursing education in Brazil.

OBJECTIVES: to analyze the influence of privatization and geographic inequalities in the distribution and expansion of higher education in nursing in Brazil. METHODS: a cross-sectional study, with online data of 1,244 courses and 190,610 nursing vacancies, started between 1890 and 2019. Proportions were estimated and differences were verified with statistical tests (α=5%), vacancy rate per 10,000 inhabitants and private ratio/public. RESULTS: there was an accelerated, disorderly and heterogeneous growth in the number of courses and vacancies for nursing over 129 years, with strong private influence, favoring their concentration in large urban centers, capitals and richer states. CONCLUSIONS: the significant expansion of higher education in nursing in Brazil occurred with excessive private supply and unequal distribution between its locations, indicating the need for state regulation in the opening of new courses and vacancies, which can minimize the negative repercussions on the quality of education, health care and workforce imbalances.

Seguindo o dinheiro: análise dos repasses financeiros do Município do Rio de Janeiro, Brasil, para as organizações sociais de saúde / Following the money: an analysis of financial transfers from the municipality of Rio de Janeiro, Brazil to social health organizations / Siguiendo al dinero: análisis de las transferencias financieras del municipio de Río de Janeiro, Brasil a las organizaciones sociales de salud

Este artigo analisou a atuação das Organizações Sociais de Saúde (OSS) no Sistema Único de Saúde (SUS) e o uso dos contratos de gestão e dos termos aditivos como instrumentos de privatização. O objetivo foi compreender os processos que legitimam a privatização, a partir da quantificação dos valores financeiros repassados por meio de contratos de gestão e termos aditivos para as organizações que firmaram contratos com a Secretaria Municipal de Saúde do Rio de Janeiro (SMS-RJ), Brasil, entre 2009 e 2018. Foi desenvolvido um estudo descritivo e exploratório com abordagem mista para analisar os valores repassados às OSS. Trabalhou-se com dados secundários públicos e disponíveis nos portais eletrônicos da SMS-RJ, além de outros documentos oficiais. Foram identificados 268 documentos, sendo 61 contratos e 207 aditivos, relacionados a 15 instituições. O volume financeiro total repassado a essas organizações foi de BRL 15,94 bilhões. A OSS IABAS (Instituto de Atenção Básica e Avançada à Saúde) foi a que mais recebeu recursos públicos, somando BRL 4,021 bilhões. Em 2014, o orçamento total da saúde do município do Rio de Janeiro foi de aproximadamente BRL 4 bilhões, sendo que desse montante BRL 2,5 bilhões foram repassados para as OSS, representando 62% do orçamento da saúde. Com base nos dados, podemos afirmar que os contratos de gestão e os termos aditivos são instrumentos de privatização do SUS. Essa privatização não se dá no modelo convencional, mas em um tipo funcional e flutuante.

This article analyzed the activity of Social Health Organizations (OSS) in the Brazilian Unified National Health System (SUS) and the use of management contracts and contract addenda as instruments of privatization. The article aimed to understand the processes that legitimize privatization, based on quantification of the amounts transferred through management contracts and contract addenda to organizations that signed contracts with the Rio de Janeiro Municipal Health Department, Rio de Janeiro, Brazil, from 2009 to 2018. A descriptive, exploratory, mixed-methods study was developed to analyze the amounts transferred to the OSS. The study used secondary public data available on the Health Department's websites and other official documents. A total of 268 documents were identified, 61 of which were contracts and 207 addenda, related to 15 institutions. The funds transferred to these organizations totaled BRL 15.94 billion (USD 2.9 billion). The OSS that received the most public funds was IABAS (Institute of Primary and Advanced Health Care), with a total of BRL 4.021 billion (USD 731 million). In 2014, Rio de Janeiro's total health budget was approximately BRL 4 billion (USD 727 million), of which BRL 2.5 billion (USD 455 million) was transferred to OSS, representing 62% of the municipal health budget. The data show that management contracts and contract addenda serve as instruments for privatization of the SUS. This privatization does not employ the conventional model but a functional and fluctuating one.

Este artículo analizó la actuación de las Organizaciones Sociales de Salud (OSS) en el Sistema Único de Salud (SUS), así como el uso de los contratos de gestión y anexos como instrumentos de privatización. El objetivo fue comprender los procesos que legitiman la privatización, a partir de la cuantificación de los valores financieros transferidos mediante contratos de gestión y anexos a organizaciones que firmaron contratos con la Secretaría Municipal de Salud de Río de Janeiro (SMS-RJ), Brasil, entre 2009 y 2018. Se desarrolló un estudio descriptivo y exploratorio con un abordaje mixto para analizar los valores transferidos a las OSS. Se trabajó con datos secundarios públicos y disponibles en los portales electrónicos de la SMS-RJ, además de otros documentos oficiales. Se identificaron 268 documentos, siendo 61 contratos y 207 anexos, relacionados con 15 instituciones. El volumen financiero total transferido a esas organizaciones fue de BRL 15,94 mil millones. La OSS IABAS fue la que más recursos públicos recibió, sumando BRL 4,021 mil millones. En 2014, el presupuesto total de salud del municipio de Río de Janeiro fue de aproximadamente BRL 4 mil millones, siendo que de ese montante BRL 2,5 mil millones fueron transferidos a las OSS, representando un 62% del presupuesto de la salud. En base a estos datos, podemos afirmar que los contratos de gestión y los anexos son instrumentos de privatización del SUS. Esa privatización no se produce en el modelo convencional, sino en un tipo funcional y fluctuante.

A regulamentação das parcerias público-privadas como tática para aprofundar a privatização das universidades federais e do aparato público de ciência e tecnologia no Brasil / The regulation of public-private partnerships as a tactic to deep in the privatization of federal universities and the public science and technology apparatus in Brazil

O presente texto traz reflexões sobre as novas regulamentações que incidem sobre a gestão da educação superior pública e do aparato público de ciência, tecnologia e inovação. Trazemos, neste artigo, parte dos resultados de um estudo documental realizado sobre normas e legislações federais que afetam as universidades federais brasileiras no século XXI. Nosso percurso analítico compreende que os dispositivos legais que regulamentam as parcerias público-privadas, e principalmente o novo Marco de Ciência, Tecnologia e Inovação (Lei n.º 13243/2016), são táticas que aprofundam o processo de privatização da política educacional superior. Esse movimento de contrarreforma do Estado sobre o financiamento impacta na autonomia universitária e altera o papel social desempenhado pelas universidades federais brasileiras, colocando-as ainda mais a serviço do mercado. Por isso, essas modificações ocorridas no século XXI representam o aprofundamento e o aprimoramento da ofensiva neoliberal às políticas sociais, em específico as políticas de educação superior e de ciência e tecnologia.

This text shares reflections on the new regulations that affect the management of public higher education and the public apparatus of science, technology and innovation. Based on documentary study on federal rules and laws that affect Brazilian federal universities since the beginning of the 21st century, our analytical path understands that the legal devices that regulate public-private partnerships, and especially the new Framework for Science, Technology, and Innovation (Law 13.243/2016), are tactics that deepen the privatization process of higher education policy. This process keeps the counter-reform of the State on financing that impacts on the university autonomy and change the social role played by Brazilian federal universities, placing the mat the service of market needs. For this reason, these changes that occurred in the 21st century represent the deepening of the direction and improvement of the eoliberal offensive to social policies, in this case, Brazilian public universities.

Profissão e profissionalização de cuidadores: um estudo a partir dos discursos de sites de empresas especializadas no Brasil / Profession and professionalization of caregivers: a study based on the discourse in websites of specialized companies in Brazil

No Brasil, a precariedade das políticas públicas voltadas ao cuidado abriu espaço para a privatização e mercantilização do cuidado por meio de planos de saúde e outros tipos de serviços de assistência oferecidos pelas empresas e agências de home care. Mediante esse contexto, o objetivo deste estudo é analisar o discurso empresarial oficial brasileiro sobre o profissional e a profissionalização do cuidador. Para isso, desenvolveu-se um estudo descritivo, de abordagem qualitativa. Os dados foram empreendidos a partir da seleção de discursos apresentados em sites de empresas que oferecem a contratação e/ou indicação dos serviços de cuidador profissional. Para a interpretação do material coletado, utilizou-se o aparato teórico-metodológico de análise do discurso em sua vertente francesa. Dentre os principais resultados, destacamos o discurso da humanização, compromisso e emoções do cuidado propagado pelas empresas em uma tentativa de omitir a relação comercial proveniente da dinâmica dessa ocupação e da precarização das relações de trabalho no âmbito desse mercado.

In Brazil, the precariousness of public policies focused on care made room for the privatization and commodification of care through health plans and other types of assistance services offered by home care companies and agencies. In this context, the objective of this study is to analyze the official Brazilian business discourse about the professional and the professionalization of caregivers. For this, a descriptive study with a qualitative approach was developed. Data were collected through the selection of discourses presented on websites of companies that offer the hiring and/or indication of professional caregiver services. For the interpretation of the collected material, the theoretical-methodological apparatus of French discourse analysis was used. Among the main results, we highlight the discourse of humanization, commitment and emotions of care propagated by companies in an attempt to omit the commercial relationship arising from the dynamics of this occupation and the precariousness of labor relations within this market.

"A gente nunca pensou que teria que recomeçar": histórias de vida na extinção das fundações do Rio Grande do Sul / "We never thought we would have to start over": life stories in the extinction of foundations in Rio Grande do S

No âmbito das políticas neoliberais, é possível localizar, na história recente do Estado do Rio Grande do Sul, gestões que aderiram fielmente a esses preceitos, como o recente governo de José Ivo Sartori (2015-2018). Essa optou por combinações de políticas de austeridade e de reformas a partir da diminuição da participação do Estado na sociedade. Nosso artigo busca refletir sobre as condições de vida e de trabalho dos servidores públicos estaduais gaúchos frente à crise e compreender como um casal de servidores engendra possibilidades de enfrentamento à precarização das relações de trabalho - produto da gestão neoliberal - que outrora estruturavam a vida familiar. A partir das histórias de vida de Maria e João, discorremos sobre a flagrante piora nas condições de trabalho, seja na infraestrutura e no remanejamento arbitrário, seja nos planos de carreira ou mesmo em suas estabilidades. Refletimos que, no âmbito da crise, há precarização da vida e na produção da subjetividade desses trabalhadores, o que desemboca na assunção de novos papéis sociais e reconfigurações relacionais na conjugalidade.

Within the scope of neoliberal policies, it is possible to locate, in the recent history of the State of Rio Grande do Sul, administrations that faithfully adhered to these precepts, such as the José Ivo Sartori's administration (2015-2018). This administration opted for austerity and reform policy combinations, based on the decrease of the State's participation in society. Our article seeks to reflect on the living and working conditions of the State's civil servants in the face of the crisis and to understand how a couple of civil servants engender possibilities of coping with the precariousness - a product of neoliberal management - of labor relations that once structured family life. Based on the life stories of Maria and João, we talk about the flagrant worsening in working conditions, whether in infrastructure and arbitrary relocation, in career plans or even in their stability. We reflect that, in the crisis, there is a precariousness in workers' life and production of subjectivity, which leads to the assumption of new social roles and relational configurations in conjugality.

Do Medicare and Medicaid Payer-Mix Change After the Privatization of Public Hospitals?

This study assessed the impact of public hospitals' privatization on payer-mix. We used a national sample of nonfederal, acute care, public hospitals in 1997 and followed them through 2013, resulting in a cohort of 492 hospitals (8,335 hospital-year observations). Privatization to for-profit (FP) status was associated with a greater increase in Medicare payer-mix (ß = 0.13; p ≤ .001), compared with a smaller increase for privatization to not-for-profit (NFP) status (ß = 0.02; p ≤ .05). FP privatization was associated with a greater decrease in Medicaid payer-mix (ß = -0.09; p ≤ .001), compared with NFP privatization (nonsignificant). There is a larger change in payer-mix after FP privatization than after NFP privatization.