Despite many countries introducing privatised healthcare in recent years, research suggests the most satisfied patients reside in countries with public health services.
Recently, there has been an increasing number of countries shifting from public health services to a privatised system. One of the key arguments in favour of privatised healthcare is that a competitive market will drive standards and lead to more efficient health services. However, evidence from recent research suggests many prefer tax-funded, public health services.
Europeans more satisfied with public health services
“We found that Europeans are generally most satisfied in countries where the public sector is in charge of most of the health care system,” said Pål Erling Martinussen, professor at NTNU’s (the Norwegian University of Science and Technology) Department of Sociology and Political Science.
Martinussen has been working alongside Håvard Thorsen Rydland of the Research Centre (NORCE), carrying out a study into healthcare across 21 European countries. Martinussen and Ryland’s research examined the relationship between the rate of market adaptation in a country’s health care system and patient satisfaction. Martinussen and Ryland’s research study is one of few to independently research this relationship.
Martinussen and Ryland observed that although patients had more freedom of choice in a private healthcare system, patients were generally more satisfied with public health services. Private healthcare reform aims to provide the population with more choice and thus increase competition amongst providers. “In short, this hasn’t resulted in more satisfied patients,” said Martinussen. “In fact, no one has used the population’s satisfaction as a measure of the success of the changes,” added Martinussen.
The Norwegian model
Martinussen and Ryland conducted their research by examining the levels of funding for public health services in each country, the proportion of private hospital beds, and the degree of public coverage. Using this method, the researchers were able to observe results over long and short periods.
An example of a successful market-orientated, health reform comes from the Norwegian model, which was introduced between 1997 and 2002. Norway’s reforms were based around ‘effort-driven financing’, meaning hospitals were partly financed based on how many patients they treated. In 2002, Norway’s hospitals were organised into enterprises. The philosophy behind this reform is that the public sector remains responsible for public health services whilst the providers can be private.
“Key elements of the reform are greater hospital independence, more centralised power to the state, increased use of contracts as a form of government, professionals instead of joint boards, greater separation between health policy and service production and increased freedom of choice for patients”, explained Martinussen.
Despite the evidence supporting public health services, Martinussen and Ryland acknowledge the benefits of a privatised healthcare system. “It’s clear that there are also advantages to competition in a public system. Private actors have relieved some of the pressure on the public health service,” said Martinussen. However, the researchers stress in their report that the reason this approach works is that funding and regulations remain public, it is only the providers that are private.
