Political Determinants of Health: Healthcare Privatization and Population Health in Europe.

The extent to which healthcare reforms affect health remains understudied. Healthcare reforms result in policy outputs that determine provision of medical services, which have consequences for the health of the population. We scrutinize this relationship between health policy outputs and population health, using an original dataset of healthcare reforms passed in 36 European countries from 1989 to 2019. Focusing more specifically on legislative changes implying privatization of healthcare delivery and finance, we ask the following question: What is the relationship between reforms that privatize healthcare provision and population health in terms of health outcomes and inequalities? We answer this question by relying on fixed effects time-series cross-section models. Health outcomes are operationalized using measures of subjective health status, unmet health needs and resulting health inequalities. Our results show that privatization of healthcare is associated with higher rates of bad subjective health and unmet health needs several years after the passing of reforms. These effects are stronger for individuals in the lower tiers of income and education, resulting in higher socio-economic inequalities. The article contributes to conceptualization of the political determinants of health as health policy outputs and a better understanding of the relationship between policy outputs and population health outcomes.

Can Grassland Rental Lead to Herders' Rotational Grazing Under the Grassland Household Responsibility System? Evidence from Pastoral Areas in Northern China.

Grassland property rights privatization has alleviated the problem of 'the tragedy of the commons' but led to an unintended ecological consequence-traditional nomadic modes declination. However, with the grassland rental market formation in countries with property rights privatization, grassland rental has reshaped the pattern of grassland allocation and provided opportunities for herders to optimize their grazing modes. Based on the survey data of herders in northern China, we theoretically analyze and empirically test grassland rental's impact on herders' rotational grazing behavior under the household responsibility system. The results show that grassland rental promotes herders' rotational grazing, and the probability of individual rotational grazing is increased by 58.27%. By increasing the operated grazing grassland area and the number of grassland plots fenced, grassland rental promotes herders' grassland endowment match with the large-scale livestock activity space and the number of grazing blocks required for rotational grazing, reduces the input cost and operation difficulty required for rotational grazing, and increase herders rotational grazing probability. Grassland rental's impact on herder's rotational grazing is heterogeneous, showing the dependence of the number of plots fenced and the scale of grazing grassland. It has a higher promotion effect on herders with more plots fenced; It cannot promote the generation of herders' rotational grazing behavior when the rented grassland area fails to make the grassland operation scale reach the minimum threshold of rotational grazing. The study emphasizes the importance of developing a grassland rental market to promote the optimization of grazing modes in grassland privatization countries.

Trajectories of primary health care utilization: a 10-year follow-up after the Swedish Patient Choice Reform of primary health care.

BACKGROUND: In January 2010, the choice reform was instituted in Swedish primary health care establishing free entry for private primary health care providers and enabling patients to choose freely among primary health care centers. The motivation behind the reform was to improve access to primary care and responsiveness to patient expectations. Reform effects on health care utilization have previously been investigated by using subgroup analyses assuming a pattern of homogeneous subgroups of the population. By using a different methodological approach, the aim of this study was to, from an equity perspective, investigate long term trends of primary health care utilization following the choice reform. METHOD: A closed cohort was created based on register data from Region Skåne, the third most populated region in Sweden, describing individuals' health care utilization between 2007-2017. Using a novel approach, utilization data, measured as primary health care visits, was matched with socioeconomic and geographic determinants, and analyzed using logistic regression models. RESULTS: A total of 659,298 individuals were included in the cohort. Sex differences in utilization were recorded to decrease in the older age group and to increase in the younger age group. Multivariable logistic regression showed increasing utilization in older men to be associated with higher socioeconomic position, while in women it was associated with lower socioeconomic position. Furthermore, groups of becoming high utilizers were all associated with lower socioeconomic position and with residence in urban areas. CONCLUSION: The impact of demographic, socioeconomic and geographic determinants on primary health care utilization varies in magnitude and direction between groups of the population. As a result, the increase in utilization as observed in the general population following the choice reform is unevenly distributed between different population groups.

Privatization of public goods: Evidence from the sanitation sector in Senegal.

Privatization of a public good (the management of sewage treatment centers in Dakar, Senegal) leads to an increase in the productivity of downstream sewage dumping companies and a decrease in downstream prices of the services they provide to households. We use the universe of legal dumping of sanitation waste from May 2009 to May 2018 to show that legal dumping increased substantially following privatization-on average an increase of 74%, or an increase of about 1640 trips to treatment centers each month. This is due to increased productivity of all trucks, not just those associated with the company managing the privatized treatment centers. Household-level survey data shows that downstream prices of legal sanitary dumping decreased by 5% following privatization, and DHS data shows that diarrhea rates among children under five decreased in Dakar relative to secondary cities in Senegal following privatization with no similar effect on respiratory illness as a placebo.

Before Privatization There was Its Impact: Sugar Factories in Turkey.

This paper estimates the effect of a sugar-factory privatization policy on sugar beet acreages in Turkey. It finds that sugar beet acreages decreased by more than 15% due to the 2018 privatization of several sugar factories. Farmers decreased their contracted acreages in the middle of 2018, after the privatization announcement but before the actual transfer of the institutions. Production continued to decrease in the following years for the farms that were in the "catchment area" of the privatized factory group. However, for the farms that were in the area of the factories in which privatization was subsequently canceled, the negative effect of the announcement vanished. The results show that privatization policies can significantly affect markets even before the transfer of the institutions to the private sector.

What motivates physicians to propose private services in a mixed private-public healthcare system? A mixed methods study.

BACKGROUND: Implementation of private elements, including private insurances, in public healthcare system is now common in many countries, and its impacts have been well studied. Little, however, is known about the motives leading physicians, major role players in the system, to promote the usage of private services. The aim of this study was to explore the various motives leading physicians within public systems to propose private services to their patients, while examining the possible associations to their specialty and level of commitment. METHODS: A total of 197 physicians from specialisms loaded more to private/public sectors participated in a cross-sectional telephone survey regarding their attitudes on their practices, private insurances, access to healthcare, and job satisfaction. The association between the likert scale questions to their recommendation to purchase private insurance, and the commitment they felt towards patients were analyzed using Generalized Estimating Equations (GEE) as well as logistic regression models. RESULTS: Our findings suggest physicians engaged in dual practice are less likely to promote private insurances among their patients if they are satisfied with their public job (OR = 0.92, 95%CI 0.89,0.94). Physicians perceived private insurances as beneficial for patients, were found likely to promote them (OR = 1.65, %95CI 1.16, 2.35). The commitment physicians felt toward patients who paid out-of-pocket money was associated to their sense of being trusted and valued (OR = 1.99, 95%CI 1.33, 2.88; OR = 1.5, 95%CI 1.05, 2.13 respectively). CONCLUSION: This study suggests a deeper understanding of physicians' daily experience of the private-public mix and it's consequences, and could provide a platform for future studies. Further studies on physician's role in health privatization processes are needed, and could aid policymakers in their efforts to strengthen healthcare systems around the world.

Mobile Health in China: Well Integrated or a New Divide?

The application of mobile health holds promises of achieving greater accessibility in the evolving health care sector. The active engagement of private actors drives its growth, while the challenges that exist between health care privatization and equitable access are a concern. This article selects the private internet hospital in China as a case study. It indicates that a market-oriented regulatory mechanism of private mobile health will contribute little to improving health equity from the perspectives of egalitarians and libertarians. By integrating the capability approach and the right to health, it is claimed that mobile health is a means of accessing health care for everyone, where substantive accessibility should be emphasized. With this view, this article provides policy recommendations that reinforce private sector engagement for mobile health, recognizing liberty, equity, and collective responsibility in the Chinese context.

Linking nurses' job security to job satisfaction and turnover intention during reform and privatization: A cross-sectional survey.

BACKGROUND: Reforming health care systems can influence the workers. Among the aspects that could be influenced are the perception of job security, job satisfaction and turnover intention. However, nurses' perception on job security, job satisfaction and turnover intention during health care reform and privatization is a topic yet to be explored. OBJECTIVES: To examine the link between job security, job satisfaction and turnover intention during the reform and privatization of a health care system. DESIGN: A cross-sectional survey design was utilized in this study. METHODS: The survey was composed of sociodemographic items, global job satisfaction item, global turnover items and job security scale. Data were analysed using SPSS, and univariate, bivariate and multivariate analyses tests were used. RESULTS: Although job satisfaction partially mediated the association between job security and organisational turnover during health care reform, it completely mediated the association between job security and professional turnover intention. CONCLUSIONS: Further research is needed to examine this finding. IMPLICATION FOR NURSING MANAGEMENT: The findings of this study benefit nurse managers and leaders for their evidence-based management. Moreover, this study will help them focus on practices that satisfy the staff and improve the job security by improving the communication and work on changing the policy.

Global Education Governance in the Context of COVID-19: Tensions and Threats to Education as a Public Good.

This article discusses the failure of global governance to defend and reinforce education as a public good and its public provision and regulation. Challenging the framing of states and the private sector as being equally important for the achievement of the SDGs, it calls for a reimagination of the role of global governance and an accountability structure that places the economic, social and environmental consequences of policy and financing modalities at the centre.

Price Changes in Washington Following the 2012 Liquor Privatization: An Update Through 2016 With Comparisons to California, Idaho, and Oregon.

BACKGROUND: Washington State ended their wholesale and retail monopoly on liquor on June 1, 2012, resulting in a 5-fold increase in liquor outlets in diverse store types. The legislation also included taxes at the wholesale and retail levels. This study seeks to investigate whether prices have changed from 2014 through 2016, as a follow-up to a previous study finding increases in prices from 2012 to 2014, compared to prices in other states. METHODS: We developed an index of 68 brands that were popular in Washington in early 2012. Data on final liquor prices (including taxes) in Washington and California were obtained through store visits and online sources between November 2013 and March 2014, and again between April and May 2016 for Washington only. Pricing data for Idaho and Oregon were obtained from the Statistics for Alcohol Management Database over both sampling periods. Primary analyses were conducted on the utmost brands available in the majority of the stores sampled. RESULTS: Liquor prices in Washington rose an average of 3.9% for 750 ml and 6.5% for 1.75-l containers overall from 2014 to 2016, while bordering states Idaho (+2.9%) and Oregon (+1.5%) experienced smaller increases for 750-ml and declines for 1.75-l containers (Idaho: -2.9%, Oregon: -4.9%). In the analyses of spirits prices in Washington compared to California, prices in California were 24.1% lower for 750-ml containers and 29.6% lower for 1.75-l containers. CONCLUSIONS: Our findings indicate liquor prices in Washington have increased since our 2014 assessment at a larger percentage than prices in the neighboring control states Oregon and Idaho, with varying effects on brands, container sizes, and store types. We demonstrate privatization is associated with a different pattern of prices across store types than seen in California.

Exploring the consequences of decentralization: has privatization of health services been the perceived effect of decentralization in Khartoum locality, Sudan?

BACKGROUND: The health system of Sudan has experienced several forms of decentralization, as well as, a radical reform. Authority and governance of secondary and tertiary health facilities have been shifted from federal to state levels. Moreover, the provision of health care services have been moved from large federal tertiary level hospitals such as Khartoum Teaching Hospital (KTH) and Jafaar Ibnoaf Hospital (JIH), located in the center of Khartoum, to smaller district secondary hospitals like Ibrahim Malik (IBMH), which is located in the southern part of Khartoum. Exploring stakeholders' perceptions on this decentralisation implementation and its relevant consequences is vital in building an empirical benchmark for the improvement of health systems. METHODS: This study utilised a qualitative design which is comprised of in-depth interviews and qualitative content analysis with an inductive approach. The study was conducted between July and December 2015, and aimed at understanding the personal experiences and perceptions of stakeholders towards decentralisation enforcement and the implications on public health services, with a particular focus on the Khartoum locality. It involved community members residing in the Khartoum Locality, specifically in catchments area where hospital decentralisation was implemented, as well as, affiliated health workers and policymakers. RESULTS: The major finding suggested that privatisation of health services occurred after decentralisation. The study participants also highlighted that scrutiny and reduction of budgets allocated to health services led to an instantaneous enforcement of cost recovery user fee. Devolving KTH Khartoum Teaching and Jafar Ibnoaf Hospitals into peripherals with less. Capacity, was considered to be a plan to weaken public health services and outsource services to private sector. Another theme that was highlighted in hospitals included the profit-making aspect of the governmental sector in the form of drug supplying and profit-making retail. CONCLUSIONS: A change in health services after the enforcement of decentralisation was illustrated. Moreover, the incapacitation of public health systems and empowerment of the privatisation concept was the prevailing perception among stakeholders. Having contextualised in-depth studies and policy analysis in line with the global liberalisation and adjustment programmes is crucial for any health sector reform in Sudan.

Poor Choices: The Sociopolitical Context of "Grand Theft Education".

In recent years, districts have paid special attention to the common practice of "district hopping," families bending geographic school assignment rules by sending a child to a school in a district where the child does not formally reside-usually to a district that is more desirable because of higher performing schools or greater educational resources. In several high-profile cases, mothers who engaged in district hopping were charged with "grand theft" of educational services. By situating these cases in the broader context of market-based reforms, we refocus attention on the responses of districts rather than the actions of parents. We argue that increased privatization of education and growing dominance of a "private-goods" model of schooling create the conditions necessary for framing these actions as "theft."

Public-private partnerships for universal health coverage? The future of "free health" in Sri Lanka.

Sri Lanka reports impressive health indicators compared to its peers in the South Asian region. Maternal and infant mortality are relatively low, and several intractable communicable diseases have been eliminated. The publicly financed and delivered "free" healthcare system has been critical to these health achievements. Placing the country's healthcare system in historical context, this commentary analyses the contradictions and political tensions surrounding Sri Lanka's 2018 Universal Health Coverage (UHC) policy, with attention to the Ministry of Health's plans for public-private partnerships (PPP). As economic exigencies and private interests increasingly erode the 1951 "Free Health" policy, this commentary calls for a re-envisioning of UHC that can meet people's aspirations for health and social justice.

THE ENVIRONMENTAL AND SAFETY PERFORMANCE OF GAS UTILITIES IN THE UNITED STATES.

The performance of energy service providers has important environmental and safety consequences in local communities. This paper uses a novel dataset compiled from operator reports and infrastructure monitoring data obtained from three different US federal agencies to assess the performance of retail gas utilities nationwide in terms of addressing gas leaks and minimizing leak volumes. Our panel data set includes yearly observations for 727 retail gas utilities from 2009 to 2017. We show that safety hazards and environmental costs of gas leaks are widespread across providers that vary in terms of ownership, size, and region. We then use series of Bayesian hierarchical models to regress four outcome variables--hazardous leaks, end-year unfixed leaks, total gas volume leaked, and significant incidents--on infrastructure conditions, regional service context, and socio-economic service population characteristics. Unlike what is observed in other critical infrastructure cases such as drinking water, socioeconomic conditions are not strongly predictive of service outcomes. Public utilities exhibit better environmental performance on average, and no difference in maintenance backlogs. Because the environmental costs of poor performance--primarily in terms of methane greenhouse gas emissions--are predominantly social, policy tools such as consolidation and privatization are unlikely to improve environmental outcomes.

The privatisation of healthcare system in Bangladesh.

PURPOSE: The purpose of this paper is to examine the factors that triggered the privatisation of Bangladesh's health sector. DESIGN/METHODOLOGY/APPROACH: This study follows systematic reviews in its undertaking and is based on an extensive review of both published and unpublished documents. Different search engines and databases were used to collect the materials. The study takes into account of various research publications, journal articles, government reports, policy and planning documents, relevant press reports/articles, and reports and discussion papers from the World Health Organization, the World Bank and the Asian Development Bank. FINDINGS: While Bangladesh's healthcare sector has undergone an increasing trend towards privatisation, this move has limited benefits on the overall improvement in the health of the people of Bangladesh. The public sector should remain vital, and the government must remobilise it to provide better provision of healthcare. RESEARCH LIMITATIONS/IMPLICATIONS: The paper focusses only on the public policy aspect of privatisation in healthcare of a country. PRACTICAL IMPLICATIONS: The paper examines the issue of privatisation of healthcare and concludes that privatisation not only makes services more expensive, but also diminishes equity and accountability in the provision of services. The study, first, makes a spate of observations on improving public healthcare resources, which can be of value to key decision makers and stakeholders in the healthcare sector. It also discourages the move towards private sector interventions. ORIGINALITY/VALUE: This study is an independent explanation of a country's healthcare system. Lesson learned from this study could also be used for developing public policy in similar socio-economic contexts.

Why nurses should be Marxists.

The argument that nurses should be Marxists is made by looking at the primary areas of nursing activity in turn, giving an example of how capitalist economic relations negatively impact upon that activity, and providing a Marxist explanation of the reasons why it has that impact. In relation to the nursing activity of health promotion, it is argued that capitalism's generation of social inequality undermines the health of the population. In relation to curative activities, the focus is on how capitalism's reckless pursuit of profit has subverted the sustainability of bactericidal interventions. The argument in relation to comforting and assistive care is that the ownership and control of health services by capitalist corporations undermines therapeutic relationships. Finally, in relation to supportive care, it is contended that capitalism's requirement for a disciplined workforce can compromise healthcare professionals' support of employees. It is concluded that if nurses aspire to have some control over their activities, then it is a good idea for them to avail of Marxism's capacity to identify the socio-economic mechanisms by which capitalism affects nursing care.

Washington State Spirits Privatization: How Satisfied were Liquor Purchasers Before and After, and by Type of Retail Store in 2014?

BACKGROUND: In 2012 Washington State ended a wholesale/retail monopoly on liquor, permitting sale of spirits in stores with > 10,000 square feet. Implementation resulted in average price increases, but also five times the stores selling liquor. OBJECTIVES: As part of a privatization evaluation, we studied pre-post and between-store-type purchase experiences. METHODS: A 2010 Washington State Liquor Control Board (LCB) survey of liquor purchasers (n = 599), and the 2014 baseline of a repeated telephone survey (1,202 residents; n = 465 purchasers), each included 10 LCB questions on satisfaction with purchase experiences, each attribute with graded response scale A = 4 to D = 1 and F (0 = fail). Analyses used t-tests for satisfaction differences by time and analysis of variance (ANOVA) for 2014 between-store satisfaction-level differences. RESULTS: Five purchase features were rated more favorably after privatization (ps < .05-.001), including product supply, staff professionalism, location convenience, store hours, and prices (though price rated lowest both times); selection offered, courtesy, and checkout speed were unaltered, and number of staff and staff knowledge declined (both p < .001). Eight consumer experiences differed by store type: five satisfaction aspects (supply, selection, number of staff, operating hours, and checkout speed) were highest for liquor superstores, while location convenience favored grocery and drug stores, and price satisfaction favored wholesale (Costco) stores, with staff knowledge highest at liquor stores. CONCLUSIONS: Satisfaction with liquor purchases increased after privatization for half the consumer experiences. Availability (location convenience and store hours) was important to liquor purchasers. Such results are relevant to sustained support for the policy of privatizing spirits retail monopolies.

Out of Sight, Out of Mind? Measuring the Relationship between Privatization and Medicaid Self-Reporting.

Privatization has grown exponentially, both in salience and in form, over the past several decades. This shifting of administrative authority away from the state can make it difficult for program recipients to link their use of a federal program back to government, a disconnect known as "submerging" the state. However, privatization is a process that occurs in degrees, and not all privatization initiatives look alike. This study leverages variation in the implementation of Medicaid managed care, which is the most widespread form of Medicaid privatization, to examine how privatization maps onto state submersion and affects state visibility. This analysis shows that, although Medicaid managed care enrollment, at large, does not relate to recipients' self-reported Medicaid enrollment, when privatized Medicaid plans introduce administrative designs that obscure the role of government, Medicaid self-reporting declines. These findings demonstrate that policy recipients are less able to recognize both the personal relevance of a specific public program and the public nature of this interaction when privatized programs utilize design features that attenuate signals of government involvement. In highlighting this disconnect, this article shows how privatization makes it more difficult for policy recipients to engage in the civic sphere as informed advocates for their self-interest.