文章基本信息

标题：Privatization of Public Services: Organizational Reform Efforts in Public Education and Public Health
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作者：Sarah E. Gollust ; Peter D. Jacobson
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：10
页码：1733-1739
DOI：10.2105/AJPH.2005.068007
语种：English
出版社：American Public Health Association
摘要：The public health and the public education systems in the United States have encountered problems in quality of service, accountability, and availability of resources. Both systems are under pressure to adopt the general organizational reform of privatization. The debate over privatization in public education is contentious, but in public health, the shift of functions from the public to the private sector has been accepted with limited deliberation. We assess the benefits and concerns of privatization and suggest that shifting public health functions to the private sector raises questions about the values and mission of public health. Public health officials need to be more engaged in a public debate over the desirability of privatization as the future of public health. THE INSTITUTE OF MEDICINE’S report, The Future of Public Health in the 21st Century, 1 describes a system badly in need of reform. Underfunded and technologically immature, the United States’ public health system is characterized by quality problems, disparities across racial and socioeconomic groups, and unclear accountability within a fragmented authority structure. 1 ^, 2 New threats, including bioterrorism, have brought attention to weaknesses in the public health infrastructure and the need to reconsider how public health services are delivered. 3 ^– 5 We define “public health system” as the governmental and nongovernmental entities that together provide public health services encompassing the population-based core functions of assessment, policymaking, and assurance 6 ; the related 10 essential services 7 ; and, in many areas, the direct provision of personal health services to vulnerable populations. 8 Because the public health system is not the only social system facing similar concerns, it is useful to examine how other public systems that share characteristics with public health have reacted to similar challenges. A particularly striking similarity is found in the public education system. The 1983 report, A Nation At Risk, characterized the education system as a “rising tide of mediocrity that threatens our very future as a Nation and a people,” 9 ^(p1) which ushered in more than 20 years of reform efforts. As with public health, commentators argued that education failures resulted from problems inherent in system design. 10 Both systems tried to balance between centralized accountability and decentralized decisionmaking 11 ^, 12 while struggling with inequities and the difficult task of measuring outcomes. 12 ^, 13 To address these structural problems, each system has been experimenting with privatization options as the pathway to organizational reform. But the 2 systems have had divergent responses to privatization. In education, the debate over privatization is loud and contentious; in public health, the debate is barely audible. In education, scholarly and media arguments over privatization are common. By contrast, there have been only a few similar analyses of privatization in public health. 14 ^– 20 Even though the privatization tactics in education differ from those being pursued within public health, and there are certainly organizational differences between them, we suggest that the arguments within education, and the lessons learned, are meaningful for a public health audience. Analyzing the analogous experience in public education can broaden the debate about public health privatization and elucidate key issues for the public, practitioners, and policymakers to consider.