Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, FBE Building, L5, 111 Barry Street, Parkville, Victoria 3010, Australia.
Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, FBE Building, L5, 111 Barry Street, Parkville, Victoria 3010, Australia.
Health Policy. 2021 Nov;125(11):1475-1481. doi: 10.1016/j.healthpol.2021.09.005. Epub 2021 Sep 20.
This study examines whether greater private-sector participation in aged care can lead to better outcomes by comparing quality of care and prices of residential aged care facilities across three ownership types: government-owned, private not-for-profit and for- profit facilities. Australia, like many other countries, has been implementing market-oriented reforms aiming to promote greater consumer choice and increase the role of markets and private-sector participation in aged care.
Using retrospective facility-level data, the study relates several measures of quality of care and a measure of price to ownership types while controlling for facility characteristics. The data covered six financial years (2013/14-2018/19) and contained 2,900 residential aged-care facilities, capturing almost all facilities in Australia. About 55% were private not-for-profit, 30% private for-profit and 15% government-owned.
Government-owned facilities provide higher quality of care in most quality measures and charge the lowest average price than private for-profit and not-for-profit facilities.
Reforms promoting private-sector participation in aged care are unlikely to result in effective competition to drive quality up or prices down unless sources of market failure are addressed. In Australia, the lack of public reporting of quality and the complex pricing structure are key issues that prevent market forces and consumer choice from working as intended.
本研究通过比较三种所有制类型（政府所有、私营非营利和营利性设施）的养老院护理质量和价格，考察私营部门更多地参与老年护理是否能带来更好的结果。与许多其他国家一样，澳大利亚一直在实施以市场为导向的改革，旨在促进更多的消费者选择，并增加市场和私营部门在老年护理中的作用。
本研究使用回顾性设施层面数据，在控制设施特征的同时，将护理质量的几个衡量指标和价格衡量指标与所有制类型联系起来。该数据涵盖了六个财政年度（2013/14-2018/19），包含了 2900 家养老院，几乎涵盖了澳大利亚所有的养老院。约 55%为私营非营利性，30%为私营营利性，15%为政府所有。
在大多数质量衡量指标中，政府所有的设施提供的护理质量更高，平均收费也低于私营营利性和非营利性设施。
除非解决市场失灵的根源，否则促进私营部门参与老年护理的改革不太可能带来有效竞争，以提高质量或降低价格。在澳大利亚，缺乏质量的公共报告和复杂的定价结构是阻碍市场力量和消费者选择按预期发挥作用的关键问题。
