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.

The effect of health-care privatisation on the quality of care.

Over the past 40 years, many health-care systems that were once publicly owned or financed have moved towards privatising their services, primarily through outsourcing to the private sector. But what has the impact been of privatisation on the quality of care? A key aim of this transition is to improve quality of care through increased market competition along with the benefits of a more flexible and patient-centred private sector. However, concerns have been raised that these reforms could result in worse care, in part because it is easier to reduce costs than increase quality of health care. Many of these reforms took place decades ago and there have been numerous studies that have examined their effects on the quality of care received by patients. We reviewed this literature, focusing on the effects of outsourcing health-care services in high-income countries. We found that hospitals converting from public to private ownership status tended to make higher profits than public hospitals that do not convert, primarily through the selective intake of patients and reductions to staff numbers. We also found that aggregate increases in privatisation frequently corresponded with worse health outcomes for patients. Very few studies evaluated this important reform and there are many gaps in the literature. However, based on the evidence available, our Review provides evidence that challenges the justifications for health-care privatisation and concludes that the scientific support for further privatisation of health-care services is weak.

Increased privatization of a public resource leads to spread of cooperation in a microbial population.

The phenomenon of cooperation is prevalent at all levels of life. In one such manifestation of cooperation in microbial communities, some cells produce costly extracellular resources that are freely available to others. These resources are referred to as public goods. Saccharomyces cerevisiae secretes invertase (public good) in the periplasm to hydrolyze sucrose into glucose and fructose, which are then imported by the cells. After hydrolysis of sucrose, a cooperator retains only 1% of the monosaccharides, while 99% of the monosaccharides diffuse into the environment and can be utilized by any cell. The non-producers of invertase (cheaters) exploit the invertase-producing cells (cooperators) by utilizing the monosaccharides and not paying the metabolic cost of producing the invertase. In this work, we investigate the evolutionary dynamics of this cheater-cooperator system. In a co-culture, if cheaters are selected for their higher fitness, the population will collapse. On the other hand, for cooperators to survive in the population, a strategy to increase fitness would likely be required. To understand the adaptation of cooperators in sucrose, we performed a coevolution experiment in sucrose. Our results show that cooperators increase in fitness as the experiment progresses. This phenomenon was not observed in environments which involved a non-public good system. Genome sequencing reveals duplication of several HXT transporters in the evolved cooperators. Based on these results, we hypothesize that increased privatization of the monosaccharides is the most likely explanation of spread of cooperators in the population.IMPORTANCEHow is cooperation, as a trait, maintained in a population? In order to answer this question, we perform a coevolution experiment between two strains of yeast-one which produces a public good to release glucose and fructose in the media, thus generating a public resource, and the other which does not produce public resource and merely benefits from the presence of the cooperator strain. What is the outcome of this coevolution experiment? We demonstrate that after ~200 generations of coevolution, cooperators increase in frequency in the co-culture. Remarkably, in all parallel lines of our experiment, this is obtained via duplication of regions which likely allow greater privatization of glucose and fructose. Thus, increased privatization, which is intuitively thought to be a strategy against cooperation, enables spread of cooperation.

Exploring the Preferences of Parents of Children with Myopia in Rural China for Eye Care Services Under Privatization Policy: Evidence from a Discrete Choice Experiment.

OBJECTIVES: This study aims to measure the preferences and valuations of parents of students with myopia parents for eye care service attributes in rural China, and to quantify the potential welfare impacts of privatization policy on children's eye care services. METHODS: A discrete choice experiment was designed and implemented among a sample of parents of children with myopia in rural China. We randomly selected 350 participants from the list of subjects obtained from local town schools and family doctors using a random number table method. The participants were asked to choose between two hypothetical scenarios defined by five attributes: provider type, distance, price, lenses type, and refractionists' professional competencies. We estimate conditional logit and mixed logit models to approximate individual preferences for these attributes and estimate the welfare effects by calculating willingness to pay. RESULTS: Respondents (n = 336) showed a significant preference for public providers of refractive error services, myopia control lenses, and professional refractionists (P < 0.01 for each). Consumer welfare losses due to a prohibition of the public provision of refractive error services could be compensated by improving the quality of products and services delivered by private providers. Lastly, both parent and child demographics and previous experience of eye care service consumption are important predictors of willingness to pay for refractive error services. CONCLUSIONS: The privatization policy on children's eye care services would not cater to the preferences of rural consumers, inevitably leading to welfare losses. However, reduced consumer welfare could be compensated by improving the quality of products and service delivery from private providers. These results could help inform strategies to improve and reduce inequities in access to high-quality eye care services in rural China.

Partial privatization and cooperation in biofilms.

The evolution of cooperation in microbes is a challenge to explain because microbes producing costly goods for the benefit of any strain types (cooperators) often withstand the threat of elimination by interacting with individuals that exploit these benefits without contributing (defectors). Here we developed an individual-based model to investigate whether partial privatization via the partial secretion of goods can favor cooperation in structured, surface-attaching microbial populations, biofilms. Whether partial secretion can favor cooperation in biofilms is unclear for two reasons. First, while partial privatization has been shown to foster cooperation in unstructured populations, little is known about the role of partial privatization in biofilms. Second, while limited diffusion of goods favors cooperation in biofilms because molecules are more likely to be shared with genetically-related individuals, partial secretion reduces goods that could have been directed towards genetically related individuals. Our results show that although partial secretion weakens the role that limited diffusion has on fostering cooperation, partial secretion favors cooperation in biofilms. Overall, our results provide predictions that future experiments could test to reveal contributions of relatedness and partial secretion to the social evolution of biofilms.

Ownership psychology as a "cognitive cell" adaptation: A minimalist model of microbial goods theory.

Microbes perfect social interactions with intuitive logics and goal-directed reciprocity. These multilevel, cognition-resembling adaptations in Dictyostelid cellular molds enable individual-to-group viability through public/private bacterial farming and dynamic marketspaces. Like humans and animals, Dictyostelid livestock-ownership depends on environmental sensing, cooperation, and competition. Moreover, social-norm policing of cosmopolitan colonies coordinates farmer decisions, phenotypes, and ownership identities with bacteria herding, privatization, and consumption.

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.

Health Sector Reform in Honduras: Privatization as Institutional Bad Faith.

I address the privatization of public health care services in Honduras by focusing on one family's experiences using both private and public health services. I juxtapose their increasing use of private health care services, over public services, against sustained and consistent episodes of health sector reform culminating in protests against decrees that sought to further restructure the Ministry of Health during early 2019. By complementing the concept of "privatization by attrition" with "institutional bad faith," I argue that the increased use of private health care may be understood as privatization by coercion.

Impacto da privatização da água e do esgoto nas tarifas e no acesso aos serviços no Brasil / The impact of water and sewer privatization on tariffs and access in Brazil / El impacto de la privatización del agua y del alcantarillado en las tarifas y en el acceso a los servicios en Brasil

Resumo Este trabalho se propõe a verificar o impacto das concessões à iniciativa privada dos serviços de saneamento sobre o acesso à água e ao esgoto tratados, bem como sobre as tarifas cobradas por esses serviços. O presente estudo se faz relevante à luz das recentes alterações legislativas no setor, à guisa da Lei n. 14.026/2020, e da necessidade de universalização do saneamento. Como método, foi utilizado o modelo diferenças em diferenças, para dados de 3.536 municípios brasileiros retirados do Sistema Nacional de Informações sobre Saneamento (SNIS), abrangendo o período de 1998 a 2019. Os resultados mostram impacto positivo e estatisticamente significativo dos prestadores privados (em relação aos públicos) sobre o acesso aos serviços de água, esgoto e tratamento de esgoto. Ademais, foi observado impacto positivo e estatisticamente significativo na tarifa praticada quando da concessão à iniciativa privada dos serviços, em comparação aos preços cobrados por prestadores públicos.

Abstract This paper aims to verify the impact of water and sewer services privatization on access and the tariffs charged for them. This paper is relevant mainly due to the sector's recent legal changes that resulted in Law n. 14.026/2020 and the need to universalize sanitation services in Brazil. The differences-in-differences method was employed to estimate the impact, using data from 3.536 Brazilian municipalities extracted from SNIS, the Brazilian National Sanitation Information System, for the years 1998-2019. The results show private sector operators' positive and statistically significant impact (compared to their public peers) on water and sewage services - including sewer treatment. Also, it detected a positive and statistically significant effect on the tariffs charged for those services once privatization occurs, compared to the prices charged by public sector operators.

Resumen Este trabajo se propone evaluar el impacto de las concesiones a la iniciativa privada de los servicios de saneamiento en el acceso al agua y al alcantarillado y su tratamiento, así como en las tarifas que se cobren por estos servicios. El trabajo se hace relevante a la luz de los recientes cambios legislativos en el sector, como la Ley n.o 14.026 de 2020 y de la necesidad de universalizar el saneamiento. Para el análisis se utilizó el modelo de diferencias con datos de 3536 municipios brasileños extraídos del Sistema Nacional de Información sobre Saneamiento (SNIS) que cubren el período 1998-2019. Los resultados indicaron un impacto positivo y estadísticamente significativo de los proveedores privados (en relación con los públicos) en el acceso a los servicios de agua, alcantarillado y tratamiento del alcantarillado. Además, se observó un impacto positivo y estadísticamente significativo en la tarifa cuando los servicios se concesionaron a la iniciativa privada en comparación con los precios que cobraban los proveedores públicos.

Black Queen Hypothesis, partial privatization, and quorum sensing evolution.

Microorganisms produce costly cooperative goods whose benefit is partially shared with nonproducers, called 'mixed' goods. The Black Queen Hypothesis predicts that partial privatization has two major evolutionary implications. First, to favor strains producing several types of mixed goods over nonproducing strains. Second, to favor the maintenance of cooperative traits through different strains instead of having all cooperative traits present in a single strain (metabolic specialization). Despite the importance of quorum sensing regulation of mixed goods, it is unclear how partial privatization affects quorum sensing evolution. Here, we studied the influence of partial privatization on the evolution of quorum sensing. We developed a mathematical population genetics model of an unstructured microbial population considering four strains that differ in their ability to produce an autoinducer (quorum sensing signaling molecule) and a mixed good. Our model assumes that the production of the autoinducers and the mixed goods is constitutive and/or depends on quorum sensing. Our results suggest that, unless autoinducers are costless, partial privatization cannot favor quorum sensing. This result occurs because with costly autoinducers: (1) a strain that produces both autoinducer and goods (fully producing strain) cannot persist in the population; (2) the strain only producing the autoinducer and the strain producing mixed goods in response to the autoinducers cannot coexist, i.e., metabolic specialization cannot be favored. Together, partial privatization might have been crucial to favor a primordial form of quorum sensing-where autoinducers were thought to be a metabolic byproduct (costless)-but not the transition to nowadays costly autoinducers.

Privatization and Multi-Fatality Disasters: A Causal Connection Exposing Both Worker and Citizen Health and Safety Failures in the UK?

Although several countries have experienced large-scale privatization initiatives, relatively little is known about the impact of these initiatives on the health and safety of workers and resident populations. Examining data on technical (as compared to natural) multi-fatality disasters collected in the WHO's Emergency Events Database (EM-DAT) for the UK and a number of European comparator countries for recent decades, this paper shows that the incidence of these disasters and the number of deaths resulting from them rose significantly in the UK during the period from 1979 to 1991 when the country engaged in extensive and aggressive privatization campaigns which were supported by several consecutive Conservative governments. This observed UK blip or abnormal increase in multi-fatality disasters is apparent for the UK both in terms of a "within-country" comparison (i.e., when we compare the privatization period of 1979 to 1997 with other periods), as well as when viewed in terms of comparisons with the comparable European countries of Germany, France, and Italy for the same period (1979 to 1997). Contrary to previous analyses which suggested that there is no clear link between privatization and deterioration of health and safety, this paper concludes that the UK privatization experience (1979-1997) provides robust country-specific evidence of privatization initiatives leading to increases in the number of multi-fatality technological disasters as well as related fatalities. This evidence should be seen as a deterrent to similarly extensive and aggressive initiatives which, particularly in less developed countries, could result in similarly disastrous outcomes.