Summary: An important study in the United Kingdom finds that care contracting with for-profit companies sharply raises preventable mortality. Privatization with for-profit providers threatens health outcomes in the UK and, as we have argued before, in the US.
Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study of NHS privatisation, The Lancet Public Health July 1, 2022, by Benjamin Goodair and Aaron Reeves
Background: The effects of outsourcing health services to for-profit providers are contested, with some arguing that introducing such providers will improve performance through additional competition while others worry that this will lead to cost cutting and poorer outcomes for patients. We aimed to examine this debate by empirically evaluating the impact of outsourced spending to private providers, following the 2012 Health and Social Care Act, on treatable mortality rates and the quality of health-care services in England.
Methods: For this observational study, we used a novel database composed of … procurement contracts between April 1, 2013, and Feb 29, 2020 (n=645 674…), across 173 clinical commissioning groups (CCGs; regional health boards) in England … identifying [providers] as National Health Service (NHS) organisations, for-profit companies, or charities. We supplemented these data with rates of local mortality from causes that should be treatable by medical intervention, indicating the quality of health-care services. …
Findings: We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable [preventable] mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.
Interpretation: The privatisation of the NHS in England, through the outsourcing of services to for-profit companies, consistently increased in 2013–20. Private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services.
By Don McCanne, M.D.
Recently the founders of Physicians for a National Health Program and colleagues (including me) published an article in The Nation indicating why single payer Medicare for All is not enough and community ownership of the delivery system should be involved as well – a system like the British National Health Service. See our HJM post about that here.
In the meantime, our British friends have been experimenting with the alleged benefits of for-profit competition in health care, much as is promoted by the privatizers in our country – here privatizing both the delivery system and the payment/insurance system. Although we had plenty of data to show them the adverse consequences, nevertheless they proceeded with their studies and showed that their outsourcing of services to the private, for-profit sector significantly increased the rates of treatable mortality. Their experiment with privatizing health care killed patients.
(On a personal note, please excuse my repetition of a theme I have covered before. Having recently been exposed to a series of grand mal seizures which left me in a comatose state, I was placed in “hospice at home.” But fortunately having eventually partially recovered again, I felt like I had to take this opportunity to pound home once more real reform instead of being contented with incrementalism that takes such good care of private equity in health care but leaves millions of patients in need poorly served or not served at all. I know I won’t be around to see the reform we need, but maybe some of you will have your passion drive turned up to the level that we can get the job done. I know I can’t quit, so don’t you either.)