IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v179y2017icp137-146.html
   My bibliography  Save this article

The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?

Author

Listed:
  • Barron, David N.
  • West, Elizabeth

Abstract

There has been a radical transformation in the provision of adult residential and nursing home care in England over the past four decades. Up to the 1980s, over 80% of adult residential care was provided by the public sector, but today public sector facilities account for only 8% of the available places, with the rest being provided by a mixture of for-profit firms (74%) and non-profit charities (18%). The public sector's role is often now that of purchaser (paying the fees of people unable to afford them) and regulator. While the idea that private companies may play a bigger role in the future provision of health care is highly contentious in the UK, the transformation of the residential and nursing home care has attracted little comment. Concerns about the quality of care do emerge from time to time, often stimulated by high profile media investigations, scandals or criminal prosecutions, but there is little or no evidence about whether or not the transformation of the sector from largely public to private provision has had a beneficial effect on those who need the service. This study asks whether there are differences in the quality of care provided by public, non-profit or for-profit facilities in England. We use data on care quality for over 15,000 homes that are provided by the industry regulator in England: the Care Quality Commission (CQC). These data are the results of inspections carried out between April 2011 and October 2015. Controlling for a range of facility characteristics such as age and size, proportional odds logistic regression showed that for-profit facilities have lower CQC quality ratings than public and non-profit providers over a range of measures, including safety, effectiveness, respect, meeting needs and leadership. We discuss the implications of these results for the ongoing debates about the role of for-profit providers of health and social care.

Suggested Citation

  • Barron, David N. & West, Elizabeth, 2017. "The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?," Social Science & Medicine, Elsevier, vol. 179(C), pages 137-146.
    • Handle: RePEc:eee:socmed:v:179:y:2017:i:c:p:137-146
    DOI: 10.1016/j.socscimed.2017.02.037
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953617301351
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2017.02.037?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Eric W. Christensen, 2004. "Scale and scope economies in nursing homes: A quantile regression approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(4), pages 363-377, April.
    2. Grabowski, David C. & Hirth, Richard A., 2003. "Competitive spillovers across non-profit and for-profit nursing homes," Journal of Health Economics, Elsevier, vol. 22(1), pages 1-22, January.
    3. Forder, Julien & Allan, Stephen, 2014. "The impact of competition on quality and prices in the English care homes market," Journal of Health Economics, Elsevier, vol. 34(C), pages 73-83.
    4. Mehdi Farsi & Massimo Filippini, 2004. "An Empirical Analysis of Cost Efficiency in Non‐profit and Public Nursing Homes," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 75(3), pages 339-365, September.
    5. Bercedis Peterson & Frank E. Harrell, 1990. "Partial Proportional Odds Models for Ordinal Response Variables," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 39(2), pages 205-217, June.
    6. Stephen Allan & Julien Forder, 2015. "The Determinants of Care Home Closure," Health Economics, John Wiley & Sons, Ltd., vol. 24, pages 132-145, March.
    7. Hirth, Richard A., 1999. "Consumer information and competition between nonprofit and for-profit nursing homes," Journal of Health Economics, Elsevier, vol. 18(2), pages 219-240, April.
    8. Stolt, Ragnar & Blomqvist, Paula & Winblad, Ulrika, 2011. "Privatization of social services: Quality differences in Swedish elderly care," Social Science & Medicine, Elsevier, vol. 72(4), pages 560-567, February.
    9. Pérotin, Virginie & Zamora, Bernarda & Reeves, Rachel & Bartlett, Will & Allen, Pauline, 2013. "Does hospital ownership affect patient experience? An investigation into public–private sector differences in England," Journal of Health Economics, Elsevier, vol. 32(3), pages 633-646.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Ferran Espuny Pujol & Ruth Hancock & Morten Hviid & Marcello Morciano & Stephen Pudney, 2021. "Market concentration, supply, quality and prices paid by local authorities in the English care home market," Health Economics, John Wiley & Sons, Ltd., vol. 30(8), pages 1886-1909, August.
    2. Knutsson, Daniel & Tyrefors, Björn, 2020. "The Quality and Efficiency Between Public and Private Firms: Evidence from Ambulance Services," Working Paper Series 1365, Research Institute of Industrial Economics, revised 01 Jul 2021.
    3. Jamie E. Collins & Leslie I. Boden & Daniel A. Gundersen & Jeffrey N. Katz & Gregory R. Wagner & Glorian Sorensen & Jessica A. R. Williams, 2021. "Workplace Integrated Safety and Health Program Uptake in Nursing Homes: Associations with Ownership," IJERPH, MDPI, vol. 18(21), pages 1-11, October.
    4. Bach-Mortensen, Anders Malthe & Goodair, Benjamin & Barlow, Jane, 2022. "Outsourcing and children's social care: A longitudinal analysis of inspection outcomes among English children's homes and local authorities," Social Science & Medicine, Elsevier, vol. 313(C).
    5. Goodair, Benjamin, 2023. "‘Accident and emergency’? Exploring the reasons for increased privatisation in England's NHS," Health Policy, Elsevier, vol. 138(C).
    6. Corlet Walker, Christine & Druckman, Angela & Jackson, Tim, 2024. "Growth dependency in the welfare state – An analysis of drivers in the UK's adult social care sector and proposals for change," Ecological Economics, Elsevier, vol. 220(C).
    7. Hjelmar, Ulf & Bhatti, Yosef & Petersen, Ole Helby & Rostgaard, Tine & Vrangbæk, Karsten, 2018. "Public/private ownership and quality of care: Evidence from Danish nursing homes," Social Science & Medicine, Elsevier, vol. 216(C), pages 41-49.
    8. Bach-Mortensen, Anders Malthe & Barlow, Jane, 2021. "Outsourced austerity or improved services? A systematic review and thematic synthesis of the experiences of social care providers and commissioners in quasi-markets," Social Science & Medicine, Elsevier, vol. 276(C).
    9. Corlet Walker, Christine & Druckman, Angela & Jackson, Tim, 2021. "Welfare systems without economic growth: A review of the challenges and next steps for the field," Ecological Economics, Elsevier, vol. 186(C).
    10. Kichan Yoon & Munjae Lee, 2022. "Comparative Analysis of Factors Affecting Quality of Community-Based Care Services in Korea," IJERPH, MDPI, vol. 19(8), pages 1-17, April.
    11. Ziad R. Ghandour, 2019. "Public-Private Competition in Regulated Markets," NIPE Working Papers 02/2019, NIPE - Universidade do Minho.
    12. Bilotkach, Volodymyr & Braakmann, Nils & Gonzalo-Almorox, Eduardo & Wildman, John, 2017. "The effect of house prices on the long-term care market: Evidence from England," MPRA Paper 81987, University Library of Munich, Germany.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ferran Espuny Pujol & Ruth Hancock & Morten Hviid & Marcello Morciano & Stephen Pudney, 2021. "Market concentration, supply, quality and prices paid by local authorities in the English care home market," Health Economics, John Wiley & Sons, Ltd., vol. 30(8), pages 1886-1909, August.
    2. Herr, A. & Saric, A., 2016. "The Welfare Effects of Single Rooms in German Nursing Homes: A Structural Approach," Health, Econometrics and Data Group (HEDG) Working Papers 16/23, HEDG, c/o Department of Economics, University of York.
    3. Bowblis John R. & Brunt Christopher S. & Grabowski David C., 2016. "Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities," Forum for Health Economics & Policy, De Gruyter, vol. 19(1), pages 45-70, June.
    4. Rexford E. Santerre & John A. Vernon, 2005. "Hospital Ownership Mix Efficiency in the US: An Exploratory Study," NBER Working Papers 11192, National Bureau of Economic Research, Inc.
    5. Petra Brhlikova, 2004. "Models of competition between one for-profit and one nonprofit firm," CERGE-EI Working Papers wp240, The Center for Economic Research and Graduate Education - Economics Institute, Prague.
    6. Sean Shenghsiu Huang & John R. Bowblis, 2019. "Private equity ownership and nursing home quality: an instrumental variables approach," International Journal of Health Economics and Management, Springer, vol. 19(3), pages 273-299, December.
    7. Ben-Ner Avner & Karaca-Mandic Pinar & Ren Ting, 2012. "Ownership and Quality in Markets with Asymmetric Information: Evidence from Nursing Homes," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 12(1), pages 1-33, October.
    8. Guillermo Baquero & Malika Hamadi & Andréas Heinen, 2012. "Competition, loan rates and information dispersion in microcredit markets," ESMT Research Working Papers ESMT-12-02, ESMT European School of Management and Technology.
    9. Iparraguirre, José Luis & Ma, Ruosi, 2015. "Efficiency in the provision of social care for older people. A three-stage Data Envelopment Analysis using self-reported quality of life," Socio-Economic Planning Sciences, Elsevier, vol. 49(C), pages 33-46.
    10. Jill R. Horwitz & Austin Nichols, 2007. "What Do Nonprofits Maximize? Nonprofit Hospital Service Provision and Market Ownership Mix," NBER Working Papers 13246, National Bureau of Economic Research, Inc.
    11. Jeffrey P. Ballou, 2008. "Do Nonprofit And Government Nursing Homes Enter Unprofitable Markets?," Economic Inquiry, Western Economic Association International, vol. 46(2), pages 241-260, April.
    12. Eika, Kari, 2003. "Low Quality-Effective Demand," Memorandum 36/2003, Oslo University, Department of Economics.
    13. Iris Grant & Iris Kesternich & Johannes Van Biesebroeck, 2022. "Entry Decisions And Asymmetric Competition Between Non‐Profit And For‐Profit Homes In The Long‐Term Care Market," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 63(2), pages 631-670, May.
    14. Michael Alexeev & Ivan Dedyukhin & Leonid Polishchuk, 2024. "Ownership, Asymmetric Information, and Quality of Care for the Elderly: Evidence from US Nursing Homes During the COVID-19 Pandemic," CAEPR Working Papers 2024-006 Classification-, Center for Applied Economics and Policy Research, Department of Economics, Indiana University Bloomington.
    15. Stijn Van Puyvelde & Ralf Caers & Cind Du Bois & Marc Jegers, 2015. "Does organizational ownership matter? Objectives of employees in public, nonprofit and for-profit nursing homes," Applied Economics, Taylor & Francis Journals, vol. 47(24), pages 2500-2513, May.
    16. Stephen Allan & Julien Forder, 2015. "The Determinants of Care Home Closure," Health Economics, John Wiley & Sons, Ltd., vol. 24(S1), pages 132-145, March.
    17. Eric Christensen & Richard Arnould, 2005. "The Impact of Asymmetric Information and Ownership on Nursing Home Access," International Journal of Health Economics and Management, Springer, vol. 5(3), pages 273-297, September.
    18. Arzi Adbi & Ajay Bhaskarabhatla & Chirantan Chatterjee, 2020. "Stakeholder Orientation and Market Impact: Evidence from India," Journal of Business Ethics, Springer, vol. 161(2), pages 479-496, January.
    19. Remco van Eijkel & Mark Kattenberg & Ab van der Torre, 2018. "Competition and pricing behavior in long term care markets: Evidence from the Market for Assistance in Daily Housekeeping Activities," CPB Discussion Paper 373, CPB Netherlands Bureau for Economic Policy Analysis.
    20. Jomon A. Paul & Benedikt Quosigk & Leo MacDonald, 2019. "Factors Impacting Market Concentration of Not-for-Profit Hospitals," Journal of Business Ethics, Springer, vol. 154(2), pages 517-535, January.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:179:y:2017:i:c:p:137-146. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.