A systematic review of the accessibility, acceptability, safety, efficiency, clinical effectiveness and cost-effectiveness of private providers of elective surgical services compared with public providers

Many publicly funded health systems use a mix of privately and publicly operated providers of care to deliver elective surgical services. We review the role of private elective surgical provision within publicly funded health systems in high-income countries. The outcomes evaluated include accessibility, acceptability, safety, clinical effectiveness, efficiency, and cost/cost-effectiveness. Twenty-seven articles met the review inclusion criteria. We found mixed results across each of our reported outcomes. Wait times were shorter for patients treated in private facilities in most studies, and inequalities by age and socioeconomic deprivation were found to increase with private provision in some studies. Acceptability results were mixed, with most studies finding no differences between public and private provision and others finding higher satisfaction at public facilities. The results for safety outcomes were divided, but most studies that found improved safety outcomes in private facilities, noting that private patients had a lower preoperative risk of complications. Clinical effectiveness was similar in most studies, with differences in outcomes mainly attributed to patient selection or prosthesis choice. Very few studies reported cost and cost-effectiveness outcomes, and just two included studies concluded that private facilities are economically viable.

Community Diversity and Donor Control: An Empirical Analysis of Contributions to Donor-Advised Funds at Community Foundations

This study examines the relationship between community ethnic-racial diversity and contributions to donor-advised funds (DAFs) held by community foundations. Unlike general contributions, DAFs allow donors to retain advisory control over their fund distribution based on individual preferences. In contrast to prior research that generally finds that diversity dampens private provision of public goods, we show that greater ethnic-racial diversity is significantly associated with higher levels of contributions to DAFs at community foundations but not with general contributions. The findings contribute to the literature on diversity and public goods provision and have practical implications for the policy role of private philanthropy.

Performing Through Privatization: An Ecological Natural Experiment of the Impact of the Swedish Free Choice Reform on Ambulatory Care Sensitive Conditions

Background: In 2010, Sweden opened up for establishment of privately owned primary health care providers, as part of a national Free Choice in Primary Health Care reform. The reform has been highly debated, and evidence on its effects is scarce. The present study therefore sought to evaluate whether the reform have impacted on primary health care service performance.Methods: This ecological register-based study used a natural experimental approach through an interrupted time series design. Data comprised the total adult population of the 21 counties of Sweden 2001–2009 (pre-intervention period) and 2010–2016 (post-intervention period). Hospitalizations and emergency department visits for ambulatory care sensitive conditions (ACSC) were used as indicators of primary health care performance. Segmented regression analysis was used to assess the effects of the reform, in Sweden as a whole, as well as compared between counties grouped by (i) change in private provision pre- to post reform; (ii) the timing of the implementation; and (iii) sustained presence of private providers both pre- and post-reform.Results: The results suggest that, following the introduction of the reform in Sweden as a whole, the trends in total hospitalizations rates were slowed down by 1.0% albeit acute emergency visits increased 1.1% more rapidly after the introduction of the reform. However, we found no evidence of more beneficial effects in counties where the reform had been implemented more ambitiously, specifically those with a larger increase in private primary care providers, or where the reform was introduced early and thus had longer time effects to emerge. Lastly, counties with a sustained high presence of private primary care providers displayed the least favorable development when it comes to ACSC.Conclusion: Taken together, the present study does not support that the Swedish Free Choice reform has improved performance of the primary care delivery system in Sweden, and suggests that high degree of private provision may involve worse performance and higher care burden for specialized health care. Further evaluations of the consequences of the reform are dire needed to provide a comprehensive picture of its intended and unintended impact on health care provision, delivery and results.

The role and relevance of public private partnerships in English healthcare

Health systems are now organized across England to deliver a more integrated population-based approach, not competing for services, rather collaborating and driving better value for the population from a fixed resource. This approach of health system leadership and collaboration has resulted in governance including a mixed economy of public-private provision but with greater alignment to delivering an agreed set of outcomes and value-based healthcare for the population. This dramatic shift from provider competition to collaboration and integration means a reframing of contracting and partnerships with the independent sector.

Wealth and Desired Wealth

With increasing general prosperity, desired wealth increases faster than current consumption. There is thus a secular tendency for the “waiting period” Z to grow. This is already the case for demographic reasons that hold for the global population as a whole. The proportion of the global population living in absolute poverty is rapidly declining. A monetary system offering stable purchasing power represents an important contribution of society to facilitating adequate private provision for the future. The “savings triangle” is a highly simplified, but neat representation of these interrelationships. It offers a good approximation of the facts.

Conditional cooperation in group contests

In this paper we show experimentally that conditional cooperation, a phenomenon described in the private provision of public goods, is also present in group contests, where participants’ contributions to their group performance partially determines if they overcome a rival group. This environment allows us to identify new determinants of conditional cooperation. We observe conditional cooperation in successful groups and in groups where members contribute more than rivals (even if they lose), but it vanishes in those groups that lose the contest due to low group performance. A random-effect linear panel regression analysis with an extensive set of controls confirms the findings.

Multiple Hierarchies

Islamic Studies is slowly moving beyond the long-established divide between neo/orientalist and confessional approaches. A more integrated, reflexive model is in progress at a few Islamic colleges now accredited by universities, but even then, the support flows asymmetrically from the university to the college. In addition, assumptions about the criticality of believers still pervade and divide the field, which is largely configured by gendered, epistemic, and institutional hierarchies. Yet, the growing number of Muslim students and staff, the expansion in private provision aspiring to accreditation, and even problematic political changes such as securitization, are some of the changing conditions allowing for the boundaries of the field to be negotiated and redefined more collaboratively. This is beckoning a promising though cautious move away from monological—and hierarchical—constructions of Islam and Muslims, whether as objects of enquiry or as confessional staff and students subjected to epistemic and institutional monitoring.