Private vs public child welfare systems: A comparative analysis of national safety outcome performance.

BACKGROUND: Ensuring the safety of American children is one of the chief mandates of the U.S. Child Welfare System. Yet system differences, including privatization remain an area of concern for whether safety of children is achieved. OBJECTIVE: This study examined the effect of privatization policy on the performance of state child welfare systems in terms of achieving national safety outcome standards. PARTICIPANTS AND SETTING: N1 = 10 states systems (5 privatized and 5 public systems) with N2 = 118,761 foster care cases located throughout the U.S. METHOD: Using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS), safety outcome performance measures were assessed, as were child-/case factors to predict the likelihood of the system types meeting the national safety outcome standards. RESULTS: Logistic regression models of child, case, and system factors predicting the likelihood state systems met national safety outcome performance standards were statistically significant. Private systems, compared to non-private systems, were found to have lower odds of meeting the safety outcome 1 standard (OR = 0.41, 95% CI = 0.40-0.42), but greater odds of meeting the safety outcome 2 standard (OR = 6.79, 95% CI = 6.56-7.02). CONCLUSIONS: The implementation of privatization policy in state child welfare/foster care service delivery was found to have mixed results in terms of the national safety outcome standards.

Administrative Privatization and Employment Outcomes in the Implementation of Temporary Assistance to Needy Families.

BACKGROUND: Welfare reform in the 1990s encouraged states and localities to contract out cash assistance services to for-profit and nonprofit firms operating within the private sector. Although privatized welfare delivery was heralded in the wake of Temporary Assistance to Needy Families (TANF), scant empirical research evaluates welfare privatization and its potential relationship with administrative quality and program outcomes. OBJECTIVES: This study examines the relationship between administrative privatization and TANF program outcomes, including work participation activities, unsubsidized employment, employment closure, and monthly earnings, across a large sample of individual welfare clients in the state of Florida. RESULTS: The results of methodologically appropriate hierarchical linear models demonstrate that ownership variables seldom enhance the quality of TANF outcomes, suggesting that privatization alone is not an administrative panacea in human support services. Although direct privatization effects are often found to be substantively small and inconsistent in terms of service quality improvement, in closed-case models, there is evidence that nonprofit welfare delivery is associated with superior TANF employment closure outcomes.

Cooperation and competition: balanced scorecard and hospital privatization.

PURPOSE: In 2000 the Skåne Region (a public authority) and a private contractor made a five-year agreement for the provision of both in-patient care and out-patient medical services to about 30,000 inhabitants in the south-east part of the region. The Skåne Region is the main provider of health care to about one million inhabitants in the south of Sweden and is responsible for all health care (private and public), including ten hospitals. This paper seeks to answer the question of how the Skåne Region can control and cooperate with a private contractor, entering into competition with the public health care providers in the region. DESIGN/METHODOLOGY/APPROACH: This is a longitudinal study conducted between 2001-2006. It is based on 28 taped interviews with employees responsible for the contracting process, participating observations and comprehensive secondary material. The study presents experiences made by the contractor and the public authority on how to work out and follow-up assignments within the health care sector regarding patient interest, public interest and professional medical interest. FINDINGS: Measurement within the frames of the balanced scorecard (BSC) made it possible to control both volumes and health care quality delivered by the private competing contractor. The political purchaser claims that the Skåne Region has established a cost-effective and successful control system based on trust and measurement. ORIGINALITY/VALUE: This paper reports on a control system, between public purchaser and a private provider within health care, that focuses on and follow-up not only health care production but also health care quality.

What happens when a private hospital comes to town? The impact of the 'public' to 'private' hospital shift on regional birthing outcomes.

PURPOSE: To examine the regional impact of a shift from public to private hospital care on birthing outcomes. PROCEDURES: A retrospective regional cohort study analysed the birth outcomes for 20,826 live singleton births of gestation >or=37 weeks, within one regional area in New South Wales between 1 January 1997 and 31 December 2003. Rates of intervention for induction of labour (IOL), epidural pain relief and operative mode of birth were established and analysed according to hospital type. A cascade model was then constructed for total births by hospital type. FINDINGS: Regional birthing outcomes were significantly affected by a shift from public to private hospital care. The introduction of a new private hospital birth facility in the region studied, led to 90% of all privately insured births within the region shifting to the private hospital. During the period 1997-2003, overall regional rates for IOL increased from 38 to 45%, epidural use in labour increased from 10.4 to 21.1% and the caesarean section rate increased from 14.1 to 24.75%. PRINCIPAL CONCLUSIONS: The introduction of a new private hospital birthing facility into the regional health area studied and the shift from public to private hospital birth had a profound impact on the overall birthing experiences of women in the region. This suggests that private hospital services are not a direct substitute for public hospital birthing services. The cascade effect was present for women regardless of risk category and more pronounced in the private hospital. Women who are privately insured require better information to assist them in choosing their birthing environment, rather than assuming that they are simply buying a comparable product through private insurance.

Before you open the doors: ten lessons from Florida's Faith and Community-Based Delinquency Treatment Initiative.

In 2003, the Office of Juvenile Justice and Delinquency Prevention (OJJDP) provided Florida's Department of Juvenile Justice (DJJ) with a $3.5 million grant to design and implement a faith- and community-based program for incarcerated juveniles. Florida's experience developing a completely new program has provided valuable lessons regarding important issues to consider and address before clients are referred to the program. This article enumerates 10 key lessons from Florida's experience that can provide important guidance to other sites across the country hoping to develop faith-related services for youths in institutions.

Can privatising selected services benefit the public healthcare system?: the Greek case.

The evaluation of empirical data concerning private physician consultations in public hospitals in Greece suggests that privatisation of selected public services can increase patients' freedom of choice and also improve efficiency and quality of services, thus strengthening the supply side in a mixed healthcare system. The 2001 NHS health reform in Greece provides financial incentives to public hospital physicians to consult patients 'privately' at the outpatient clinics, while remaining restrained by certain provisions regarding fees. Competition between public and private hospitals is centrally regulated, and in this case cumulative data show success for the public sector. At the same time, patient satisfaction with the new arrangement measured in this study was very high. It could be argued that, under certain conditions, attracting private funds into a public health system constitutes an opportunity to reinforce the public provision of the system.

Corporate moral responsibility in health care.

The question of corporate moral responsibility--of whether it makes sense to hold an organisation corporately morally responsible for its actions, rather than holding responsible the individuals who contributed to that action--has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom (UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially amoral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish.

Privatized biomedical research, public fears, and the hazards of government regulation: lessons from stem cell research.

This paper discusses the hazards of regulating controversial biomedical research in light of the emergence of powerful, multi-national biotechnology corporations. Prohibitions on the use of government funds can simply force controversial research into the private sphere, and unilateral or multilateral research bans can simply encourage multi-national companies to conduct research in countries that lack restrictive laws. Thus, a net effect of government regulation is that research migrates from the public to the private sphere. Because private research receives less oversight and external scrutiny than public research, it can threaten the welfare and rights of human subjects, scientific progress and openness, and the quality of the approval process for new biomedical technologies. In order to avoid the harmful effects of government regulation of biotechnology, society should promote meaningful discussion and dialogue among scientists, industry leaders, and the public before resorting to regulatory solutions. Legislative or executive initiatives should be applied with great discretion and care, and should be crafted in such a way that they protect public health and safety, promote scientific progress, and avoid the hazards of privatized research and polarized debates.

Financing the delivery of public-sector animal health services in Jamaica: pre- and post-privatization

Lack of adequate financing was a major reason for the privatization of veterinary services in Jamaica in 1992. The belief was that, with privatization, funding of animal health services delivery would improve, since staff numbers and clinical activities undertaken by the Veterinary Division were reduced. However, analyses of data revealed that, in most cases, privatization neither improved nor stemmed the declines, that had started before privatization, in the measures or indicators used. It was concluded that privatization of veterinary services did not result in any appreciable improvement in the financing of the delivery of public-sector animal health services in Jamaica in the short term (Au)