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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?

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?

West, Elizabeth and Barron, David N. (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 and Medicine, 179. pp. 137-146. ISSN 0277-9536 (Print), 0277-9536 (Online) (doi:10.1016/j.socscimed.2017.02.037)

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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 adultresidential 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 21 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.

Item Type: Article
Uncontrolled Keywords: Residential care; Nursing homes; Ownership; Quality of care; Facility regulation and control; Public sector; Public services; Quasi-markets; England
Subjects: H Social Sciences > H Social Sciences (General)
H Social Sciences > HM Sociology
Faculty / Department / Research Group: Faculty of Education & Health
Faculty of Education & Health > Centre for Positive Ageing
Faculty of Education & Health > Department of Family Care & Mental Health
Faculty of Education & Health > Health & Society Research Group
Last Modified: 28 Feb 2018 01:38
Selected for GREAT 2016: None
Selected for GREAT 2017: GREAT a
Selected for GREAT 2018: None
URI: http://gala.gre.ac.uk/id/eprint/16460

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