Anaf Julia, Freeman Toby, Baum Fran
Stretton Health Equity, Stretton Institute, University of Adelaide, North Terrace Campus, Adelaide, Australia.
Int J Soc Determinants Health Health Serv. 2025 Oct;55(4):428-440. doi: 10.1177/27551938251355452. Epub 2025 Jul 28.
Changes to the public sector in Australia over recent decades result from the adoption of neoliberal policies and New Public Management techniques. By the 1990s Australian governments were privatizing a significant portion of public sector roles, including outsourcing a range of traditional government services, policy, and decision making to the private sector, often to large global consultancy firms. While much is known about privatization and outsourcing, less is known about the health and equity impacts. Using a qualitative approach, data collection included documents, website searches, Parliament of Australia Hansard transcripts, media items, and semi-structured interviews ( = 11). Six key themes were identified, including the scope of outsourcing, consultants' strategies, conflicts of interest, undermining the public sector, poor outcomes for the public, and implications for equity. The use of private sector actors in the Australian public sector has led to promoting private over public interests. There are legitimate reasons for governments to engage the services of global consulting firms in instances when public sector capacity cannot deliver specific highly specialized work. However, the current extensive use of consultants should be decreased through rebuilding public sector capacity to promote health and equity, and public over private interests.
近几十年来,澳大利亚公共部门的变革源于新自由主义政策和新公共管理技术的采用。到20世纪90年代,澳大利亚政府将很大一部分公共部门职能私有化,包括将一系列传统政府服务、政策制定和决策外包给私营部门,通常是大型全球咨询公司。虽然人们对私有化和外包了解很多,但对其健康和公平影响却知之甚少。采用定性研究方法,数据收集包括文件、网站搜索、澳大利亚议会记录、媒体报道以及半结构化访谈(n = 11)。确定了六个关键主题,包括外包范围、顾问策略、利益冲突、损害公共部门、公众的不良结果以及对公平的影响。澳大利亚公共部门使用私营部门行为体导致了私人利益凌驾于公共利益之上。在公共部门能力无法完成特定高度专业化工作的情况下,政府聘请全球咨询公司的服务有合理理由。然而,应通过重建公共部门能力以促进健康和公平,并使公共利益高于私人利益,来减少目前对顾问的广泛使用。