University of Oxford, Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, UK.
University of Oxford, Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, UK.
Soc Sci Med. 2021 May;276:113844. doi: 10.1016/j.socscimed.2021.113844. Epub 2021 Mar 13.
Social care services are commonly delivered by a combination of for-profit, public, and non-profit sector providers. These services are often commissioned in quasi-markets, in which providers from all sectors compete for public service contracts. The outsourcing of social services to private providers has resulted in a predominantly for-profit provision. Despite the rationale that open bidding facilitates better services and improved consumer choice, the outsourcing of social care has been criticized for prioritising cost-efficiency above service quality and effectiveness. However, the experiences and perspectives of those operating within quasi-markets (providers and commissioners) are poorly understood. To address this gap, we systematically identified, appraised, and thematically synthesised existing qualitative research on social care commissioners and providers (for-profit, public, and non-profit) published in the last 20 years (2000-2020). Twenty-six studies examining the perspectives of social care providers and commissioners relating to the quasi-market provision of social care were included. The synthesis demonstrates consistent concern among non-profit and public providers with regard to spending cuts in the care sector, whereas for-profit providers were primarily concerned with creating a profitable market strategy by carefully analysing opportunities in the commissioning system. All provider types described flaws in the commissioning process, especially with regards to the contracting conditions, which were reported to force providers into deteriorating employment conditions, and also to negatively impact quality of care. These findings suggest that in a commissioning environment characterised by austerity and public budget cuts, it is insufficient to assume that increasing the market share of non-profits will alleviate issues grounded in insufficient funding and flawed contracting criteria. In other words, no ownership type can compensate for inadequate funding of social care services.
社会关怀服务通常由营利性、公共和非营利部门的提供者共同提供。这些服务通常在准市场中进行委托，所有部门的提供者都在竞争公共服务合同。将社会服务外包给私人提供者导致了主要由营利性提供。尽管公开竞标有利于更好的服务和改善消费者选择的理由，但社会关怀的外包因其优先考虑成本效益而不是服务质量和效果而受到批评。然而，对于那些在准市场中运营的人（提供者和委托方）的经验和观点却知之甚少。为了解决这一差距，我们系统地确定、评估并主题综合了过去 20 年（2000-2020 年）发表的关于社会关怀委托方和提供者（营利性、公共和非营利性）的现有定性研究。共有 26 项研究考察了社会关怀提供者和委托方对社会关怀准市场供应的观点。综合分析表明，非营利性和公共提供者普遍关注护理部门的开支削减，而营利性提供者主要关注通过仔细分析委托系统中的机会制定盈利市场策略。所有提供者类型都描述了委托过程中的缺陷，特别是在合同条件方面，据报道，这些缺陷迫使提供者陷入恶化的就业条件，也对护理质量产生负面影响。这些发现表明，在以紧缩和公共预算削减为特征的委托环境中，仅仅假设增加非营利组织的市场份额将缓解由于资金不足和合同标准缺陷而产生的问题是不够的。换句话说，没有任何所有制类型可以弥补社会关怀服务资金不足的问题。
