Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Department of Social Policy, Sociology and Criminology, University of Birmingham, Birmingham, UK.
BMJ Open. 2019 Feb 15;9(2):e022975. doi: 10.1136/bmjopen-2018-022975.
Social services are increasingly commissioned to third and for-profit sector providers, but little is known about whether and how these changes influence quality indicators. We assessed quality-related outcomes across for-profit, public and third sector organisations delivering social care services.
A secondary analysis was conducted on publically available data collected by the independent regulator of social care organisations in Scotland. All outcomes are reported as predicted probabilities derived from multivariate logistic regression coefficients. Generalised ordered logit models are utilised for the quality domains and the risk assessment score and logistic regression for whether complaints or requirements were issued to organisations.
Organisations inspected by the Care Inspectorate in Scotland.
13 310 social care organisations (eg, nursing homes and day care organisations).
The quality and risk domains collected by the Care Inspectorate and complaints and requirements issued to organisations within the last 3 years.
Controlling for multiple factors, we find that public and third sector providers performed consistently and statistically significantly better than for-profit organisations on most outcomes. For example, for-profit services were the most likely to be rated as high and medium risk (6.9% and 13.2%, respectively), and the least likely to be classified as low risk (79.9%). Public providers had the highest probability of being categorised as low risk (91.1%), and the lowest probability of having their services classified as medium (6.9%) and high risk (2%), followed by third sector providers (86%, 8.5% and 4.5%, respectively). Public providers performed better than third sector providers in some outcomes, but differences were relatively low and inconsistent.
Public and third sector providers were rated considerably higher than their for-profit counterparts on most observed outcomes. Regulators might use this information to consider how social care providers across sector are incentivised to manage their resources.
社会服务越来越多地委托给第三方和营利部门的提供者，但对于这些变化是否以及如何影响质量指标知之甚少。我们评估了提供社会关怀服务的营利、公共和第三方组织的与质量相关的结果。
对苏格兰独立社会关怀组织监管机构收集的公开可用数据进行了二次分析。所有结果均报告为来自多元逻辑回归系数的预测概率。广义有序逻辑回归模型用于质量域和风险评估评分，逻辑回归用于向组织发出投诉或要求。
在苏格兰接受护理监察员检查的组织。
13310 个社会关怀组织（如疗养院和日间护理组织）。
护理监察员收集的质量和风险域以及过去 3 年内向组织发出的投诉和要求。
在控制了多种因素后，我们发现公共和第三方提供者在大多数结果上的表现始终优于营利性组织，且在统计学上具有显著意义。例如，营利性服务最有可能被评为高风险和中风险（分别为 6.9%和 13.2%），而低风险的可能性最低（79.9%）。公共提供者被归类为低风险的可能性最高（91.1%），其服务被归类为中风险（6.9%）和高风险（2%）的可能性最低，其次是第三方提供者（分别为 86%、8.5%和 4.5%）。在一些结果中，公共提供者的表现优于第三方提供者，但差异相对较低且不一致。
在大多数观察到的结果中，公共和第三方提供者的评分明显高于营利性同行。监管机构可能会利用这些信息来考虑如何激励跨部门的社会关怀提供者管理其资源。
