背景:从历史上看,在澳大利亚,各级政府通过拥有和运营基础设施创造了集体财富,管理自然资产,关键公共产品和基本服务,同时对公众负责。这种强大的国家传统在20世纪80年代受到挑战,当时私有化成为全球广泛的政府方法。私有化涉及通过融资方式取代公共部门,所有权,管理和产品或服务交付。澳大利亚文献表明,私有化的负面影响没有公平地传播,健康和公平影响似乎研究不足。本叙述概述旨在通过回答有关私有化的积极和消极结果存在哪些证据的研究问题来解决文献中的差距;评估社会影响的程度如何,以及对健康和公平的影响。
方法:按关键词检索数据库和灰色文献,项目的纳入标准仅限于澳大利亚,在1990年至2022年之间出版,涉及任何行业或政府部门,包括评价方面,或者从私有化中找出积极或消极的方面,承包出去,或外包。主题分析由NVivo定性数据软件辅助,并由先验编码框架指导。
结果:没有明确反映私有化与健康之间关系的项目。确定的主要主题是私有化的公共成本,失去政府控制和专业知识,缺乏问责制和透明度,获得健康的社会决定因素的限制,以及私营部门应得的利益。
结论:我们的结果支持这样的观点,即私有化不仅仅是剥离公共部门的资产。这是一项为资本利益调整公共服务的综合战略,因此,私有化是健康的政治和商业决定因素。关于某些公共资产重新国有化的必要性的讨论越来越多,包括维多利亚政府。
结论:公共服务私有化可能对人口健康产生不利影响,并导致不平等现象的加剧。这篇评论表明,几乎没有证据表明私有化的好处,需要在政策制定和研究中更加关注健康的政治和商业决定因素。
BACKGROUND: Historically in Australia, all levels of government created collective wealth by owning and operating infrastructure, and managing natural assets, key public goods and essential services while being answerable to the public. This strong state tradition was challenged in the 1980s when
privatisation became a widespread government approach globally.
Privatisation involves displacing the public sector through modes of financing, ownership, management and product or service delivery. The Australian literature shows that negative effects from
privatisation are not spread equitably, and the health and equity impacts appear to be under-researched. This narrative overview aims to address a gap in the literature by answering research questions on what evidence exists for positive and negative outcomes of privatisation; how well societal impacts are evaluated, and the implications for health and equity.
METHODS: Database and grey literature were searched by keywords, with inclusion criteria of items limited to Australia, published between 1990 and 2022, relating to any industry or government sector, including an evaluative aspect, or identifying positive or negative aspects from privatisation, contracting out, or outsourcing. Thematic analysis was aided by NVivo qualitative data software and guided by an a-priori coding frame.
RESULTS: No items explicitly reflected on the relationship between
privatisation and health. Main themes identified were the public cost of
privatisation, loss of government control and expertise, lack of accountability and transparency, constraints to accessing social determinants of health, and benefits accruing to the private sector.
CONCLUSIONS: Our results supported the view that privatisation is more than asset-stripping the public sector. It is a comprehensive strategy for restructuring public services in the interests of capital, with privatisation therefore both a political and commercial determinant of health. There is growing discussion on the need for re-nationalisation of certain public assets, including by the Victorian government.
CONCLUSIONS: Privatisation of public services is likely to have had an adverse impact on population health and contributed to the increase in inequities. This review suggests that there is little evidence for the benefits of privatisation, with a need for greater attention to political and commercial determinants of health in policy formation and in research.