Public Services under Private Management

Imagem de Miniatura

Autores

Coube, Maíra
Rocha, Rudi

Orientador

Co-orientadores

Citações na Scopus

Tipo de documento

Data

2025

Unidades Organizacionais

Resumo

Theory predicts that outsourcing public services to the private sector can reduce costs and improve efficiency, but can also induce cost-cutting measures and compromise quality should the surplus rights be controlled by firms. We empirically assess the effects of the Brazilian “Organizations Sociais de Saúde” model (OSS), which involves specifically outsourcing the management of public hospital services to the private sector while keeping surplus rights with the state. We use a difference-in-differences approach to assess OSS effects, and document evidence of enhanced hospital production and operational efficiency without adverse effects on hospital quality and equity. Increased in patient production addresses previously unmet demand, expanding local access to hospital care and contributing to declines in population mortality. Performance gains primarily arise from improved operational efficiency achieved through increased hospital management capacity. Such capacity facilitates staffing adjustments, favouring higher-skilled personnel, dismissing lower-productivity staff, and adopting flexible, performance-tied employment contracts. Effects are especially pronounced among private organisations with more management experience, underscoring positive returns to managerial capacity. Our findings support the view that incentive-ownership structures can potentially address the conventional quantity-quality trade-off in public service delivery, even within the challenging policy context of a developing country.

Palavras-chave

public service delivery; healthcare management; governance and ownership

Titulo de periódico

URL da fonte

Título de Livro

URL na Scopus

Sinopse

Objetivos de aprendizagem

Idioma

Inglês

Notas

Membros da banca

Área do Conhecimento CNPQ

CIENCIAS SOCIAIS APLICADAS

Citação

Avaliação

Revisão

Suplementado Por

Referenciado Por