Barron David N, West Elizabeth
Saïd Business School, University of Oxford, Park End Street, Oxford OX1 7HP, United Kingdom.
Faculty of Education and Health, University of Greenwich, Avery Hill Campus, London SE9 2UG, United Kingdom.
Soc Sci Med. 2017 Apr;179:137-146. doi: 10.1016/j.socscimed.2017.02.037. Epub 2017 Feb 27.
There has been a radical transformation in the provision of adult residential and nursing home care in England over the past four decades. Up to the 1980s, over 80% of adult residential care was provided by the public sector, but today public sector facilities account for only 8% of the available places, with the rest being provided by a mixture of for-profit firms (74%) and non-profit charities (18%). The public sector's role is often now that of purchaser (paying the fees of people unable to afford them) and regulator. While the idea that private companies may play a bigger role in the future provision of health care is highly contentious in the UK, the transformation of the residential and nursing home care has attracted little comment. Concerns about the quality of care do emerge from time to time, often stimulated by high profile media investigations, scandals or criminal prosecutions, but there is little or no evidence about whether or not the transformation of the sector from largely public to private provision has had a beneficial effect on those who need the service. This study asks whether there are differences in the quality of care provided by public, non-profit or for-profit facilities in England. We use data on care quality for over 15,000 homes that are provided by the industry regulator in England: the Care Quality Commission (CQC). These data are the results of inspections carried out between April 2011 and October 2015. Controlling for a range of facility characteristics such as age and size, proportional odds logistic regression showed that for-profit facilities have lower CQC quality ratings than public and non-profit providers over a range of measures, including safety, effectiveness, respect, meeting needs and leadership. We discuss the implications of these results for the ongoing debates about the role of for-profit providers of health and social care.
在过去的四十年里，英国成人住宿和养老院护理服务的提供发生了根本性的转变。直到20世纪80年代，超过80%的成人住宿护理由公共部门提供，但如今公共部门设施仅占可用床位的8%，其余部分由营利性公司（74%）和非营利性慈善机构（18%）混合提供。公共部门现在的角色通常是购买者（为无力支付费用的人支付费用）和监管者。虽然在英国，私营公司未来可能在医疗保健提供中发挥更大作用的观点极具争议性，但住宿和养老院护理的转变却很少受到关注。对护理质量的担忧不时出现，往往是由备受瞩目的媒体调查、丑闻或刑事诉讼引发的，但几乎没有证据表明该行业从主要由公共提供向私人提供的转变是否对需要该服务的人产生了有益影响。本研究探讨了英国公共、非营利或营利性设施提供的护理质量是否存在差异。我们使用了英国行业监管机构——护理质量委员会（CQC）提供的15000多家养老院的护理质量数据。这些数据是2011年4月至2015年10月期间检查的结果。在控制了一系列设施特征（如年龄和规模）后，比例优势逻辑回归显示，在包括安全、有效性、尊重、满足需求和领导力等一系列指标上，营利性设施的CQC质量评级低于公共和非营利性提供者。我们讨论了这些结果对正在进行的关于营利性医疗和社会护理提供者作用的辩论的影响。
