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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?

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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 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.

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          Author and article information

          Journal
          Soc Sci Med
          Social science & medicine (1982)
          Elsevier BV
          1873-5347
          0277-9536
          April 2017
          : 179
          Affiliations
          [1 ] Saïd Business School, University of Oxford, Park End Street, Oxford OX1 7HP, United Kingdom. Electronic address: david.barron@sbs.ox.ac.uk.
          [2 ] Faculty of Education and Health, University of Greenwich, Avery Hill Campus, London SE9 2UG, United Kingdom. Electronic address: e.west@greenwich.ac.uk.
          Article
          S0277-9536(17)30135-1
          10.1016/j.socscimed.2017.02.037
          28273611
          595c46cf-48f9-4136-a6f3-a146489a7ede
          History

          Residential care,Ownership,Nursing homes,Quasi-markets,Public services,Public sector,Facility regulation and control,Quality of care,England

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