Družboslovne razprave 29 (XV)
Introduction : conflicts and cooperation between public and private social services
Veljko Rus
The (un)acceptable liberalisation of the (welfare) state
Boštjan Zalar
ABSTRACT: Any state liberalisation policy is justified to the extent that expectations of reform broadening the chances of all individuals for the better realisation of their human rights (including rights with what is termed positive status’) are reasonable. In order to fulfil this premise, justice should be combined with freedom and equality as the third basic and obligatory principle of social regulation. This standard, together with some functional conditions for liberalisation within the social services sector, leads to the conclusion that the state need not be the owner of social services. However, it is necessary that state officials exercise permanent and strict control over both the impact of liberalisation processes and the practice of social services in the private sector on all three basic regulatory principles. This premise is also highly relevant for the liberalisation processes within the executive and judicial branches of government, where special attention must be given to the maintenance of the state monopoly over the repression mechanism. The author concludes by advocating a new development paradigm which favors and connects the liberalisation of the external world with the privatisation of self.
KEY WORDS: equality, freedom, justice, human rights, privatization, ownership, control, welfare state
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Hybrid forms of privatisation
Veljko Rus
ABSTRACT: The intransigence of public and private ownership has been the common characteristic of traditional capitalism and socialism. However, this no longer holds true for post-socialist societies oriented towards the liberalisation of society; neither does it hold true for post-capitalist societies, which are now oriented towards the socialisation of the existing systems. According to the thesis above, hybrid forms of privatisation and ownership should be considered highly relevant to both types of societies. Hybrid forms of privatisation create the possibility of some sort of mezzo-corporativism, which allows for a relatively smooth and co-operative relationship between private and public ownership. However, at the same time it also creates ambiguous relationships between stakeholders. This paper will describe such hybrid forms of privatisation in different fields of social services and attempt to evaluate their policy implications.
KEY WORDS: privatisation, hybrid forms of privatisation, public services, co-opera-
tion between public and private sectors
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The study of health-care users: sampling and methodology
Mirna Macur, Majda Černič Istenič
ABSTRACT: The privatisation process of health care introduced mixed economy of care and a greater assortment of health services which has resulted in a variety of experiences among users of the same type of service. This process devided users of a particular service in a three groups according to the way of payment of the service: users of public health services, who do not pay directly (health insurance), users of health services at private practitioner with concession (health insurance), users of health services (most often at private practitioner) who pay directly for the service. In the research we compared users’ experience of health services and their satisfaction with services among the three groups of users. More specificly, in users’ evaluation of health services we were exploring: percieved changes of health services (both public and private) after the adoption of the new health legislation (the Law on Health Activities) in 1992, percieved changes in the level of health protection, user behaviour pattern in the event of dissatisfaction with the service, user aspirations regarding health services.
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Privatisation and the quality of health-care services
Mirna Macur
ABSTRACT: As social services have a special mission, privatisation of social services should not be approved if it is unable to assure the same or an increased quality of life. Quality of life, of course, does not depend solely on a greater number of services but also and especially on the higher quality of those services. Since higher quality is often one of the motives for the privatisation of health services and as it is also stated as a goal in national documents and health care programmes, the author evaluates the privatisation of health services and its impact on the quality of the health services. She finds users as the most important stakeholders in this evaluation since they experience the entire process of a health service and its outcome. Evaluation is limited to the primary health level of the services of the general physician and dentist.
KEY WORDS: quality, health service, user evaluation, privatisation of social services, satisfaction
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The impact of health insurance privatisation on risk absorption
Majda Černič Istenič
ABSTRACT: The privatisation reform introducing new methods of collecting and distributing financial resources is a possible source of growing public distrust in the health care system. Patients’ trust in their physicians could become less secure and health institutions could be viewed with diminishing confidence. The author analyses the level of trust among five groups of health service users by their inclusion in compulsory or voluntary insurance, awareness of their rights and other features of health system, their opinion regarding the accessibility of quality health services, possible consequences of the reduction of compulsory insurance rights, modes of payment for health services and their sense of security associated with the current system of health insurance. The findings confirm our hypothesis that the privatisation of health insurance system generates growing distrust into the health care system among the population. But for now the extent of a risk and uncertainty is still relatively low. Although differences between five groups of respondents are not marked, the following differentiation is very clear: the group of patients paying for health care services out of their pocket are in the most insecure situation; they participate in health care funds to the same extent as others, but are not in the position to assert their rights because their health difficulties are excluded from the insurance system. On the other hand, the users of the concession-holder services represent the most satisfied group in this sample having a fairly strong feeling of security.
KEY WORDS: quality, health service, user evaluation, privatisation of social services, risk, trust
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The study of health-care providers in Ljubljana: sampling and methodology
Anton Kramberger, Hajdeja Iglič
ABSTRACT: Povzetek članka ni na voljo.
KEY WORDS: equality, freedom, justice, human rights, privatization, ownership, control, welfare state
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Public-private mix of the primary health-care providers in Ljubljana 1992-1998: system and labour market concerns
Anton Kramberger
ABSTRACT: The article deals theoretically and empirically with pluralisation (privatisation) of providers of medical services. First, a broader socio-economic framework for policy interpretation of a health system reform is briefly sketched. Then, internal professional tensions of public health quasi-markets, with a few illustrations for transition countries, are elaborated. The empirical part focuses on the recent pluralisation of primary health care in Ljubljana, the capital of Slovenia. The basic labour market comparisons between physicians working in private practices and in public institutions are presented and discussed. It is aimed at exposing some developmental differences in recent public-private arrangements. The findings reveal an increasing awareness among all physicians of some basic malfunctions within the public institutions and of a better quality of health services, delivered by physicians in the private sector. However, they also demonstrate quite a blurring providers’ view on the sources of the system’s (in)efficiency. Physicians prefer to emphasise the administrative & organisational disadvantages of the public sector, but in terms of professional liability, still avoid directly addressing the well-known internal professional tensions in medical markets, which also were strong push-factors for them.
KEY WORDS: primary health care, physicians, Slovenia, privatisation, concession, labour market, public-private mix
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Privatisation and professional dynamics
Hajdeja Iglič
ABSTRACT: The organisation and delivery of health care throughout the world is undergoing significant organisational, social, and economic changes. These changes have important implications for the professional status of medicine since they affect the dominance, autonomy, and authority of medical practitioners. In this article we examine the professional dynamics, which underlie the process of privatisation in the field of health care in Slovenia and place it within the context of these global changes. To this end, we look first at realised and potential privatisation among primary health care doctors in Slovenia. We continue by illustrating the forms of organisation within the private sector preferred by practitioners – solo practice versus group practice – and ask what method of privatisation of public health care centres they regard as most acceptable. We take these as indicators of the widespread professional orientation of Slovenian doctors towards managed care and accountability rather than to the highly autonomous forms exemplified by the traditional solo practice. We then turn to the factors that affect doctor’s decision to move from the public to the private sector. We close with a discussion of the two phases in the privatisation of health care in Slovenia, which are characterised by different practitioner preferences with regard to the form and organisation of the private sector, as well as by different motivational structures affecting the individual’s decision to move into the private sector.
KEY WORDS: privatisation, practitioner aspirations, professional dynamics, primary health care, social capital
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Changes in the regulation of public social-service institutions as a condition for private provision of social services
Helena Kamnar
ABSTRACT: The article deals with the view that public social-service institutions are a barrier to the major development of the provision of private social services in Slovenia. In addition to the public service for which they were intended and created by the state or municipality, they also carry out services in the private sector, in the same way as commercial companies and private non-profit organisations. The regulation of ownership, governance and financial structure of public social-service institutions do not sufficiently take this fact into account, which places these institutions in an unequal position when compared with other providers of social services. They are negatively discriminated with regard to their ownership and governance structures, while their financial structure remains, as a rule, in a privileged position. Such regulation of public institutions impedes the development of the private sector. Furthermore, the vague definition of public services and improper regulations place too heavy a burden on public finances. The author suggests a change in the regulation of public institutions and, consequently, also a change of the role of the state. There will be three models drawn up for providers of social services: state institutions exclusively bound to public services, public and private providers having a concession, and public institutions providing public services, as well as services on the market.
KEY WORDS: public social-service institution, pluralisation, privatisation, public service, state regulation, private profit/non-profit
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Privatisation and culture: how to separate cultural policy from the provision of culture
Vesna Čopič
ABSTRACT: The new circumstances determined by political pluralism, a market economy and social stratification also require the transformation of cultural policy. Instead of the present-day transition, which only adapts old positions to a new environment, a strategic transformation that would improve quality and content is needed. The author believes that such a qualitative transformation calls for the redefinition of the role of the state in culture. The state used to have all three basic functions: the regulation of cultural activities; the provision of cultural services through state cultural institutions; and the subsidising of individual cultural projects. In order to establish the principles of competition, selection, transparency and accountability in the allocation of public funds for culture, the funding of cultural activities must be separated from their provision. This article will try to advance a number of arguments as to why civil society is the most appropriate partner for assuming the function of the organisation and performance of cultural services from the state, and why the state should now concentrate more on the newly-formed strategic role for culture-policy formation, i.e. establishing the general conditions for cultural development whereby a range of stakeholders, including the private and civil sectors, is brought to the surface.
KEY WORDS: cultural policy, deregulation, de-etatisation, decentralisation, autonomisation, incorporation, democratisation, publicisation
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Evaluation of two proposed laws on privatisation of public social services
Boštjan Zalar
ABSTRACT:The author compares and evaluates two legislative proposals for the privatisation of public social services, from 1994 and 1998. The evaluation criteria are taken from the legal, economic, and sociological standpoints. From the legal point of view two constitutional principles are relevant: the principle of equality before the law and the principle that human rights have to be determined only by law adopted in parliament and not by the executive regulations of the government. In terms of economic criteria it is relevant whether the legislative proposals consider specifics of activities in the area of social services in connection to mistakes and flaws of the adopted model of the ownership transformation of commercial companies from 1992. Considering legal and economic aspects the author draws the sociological conclusion that privatisation of social services should be based, along with an option of partial buy-outs of social institutions by employees, on the privatisation of activities rather than on the privatisation of material assets of social-service institutions. Further argument in this regard is the need for a change of the role of the state in the future development of social services. Both proposals are weak on all three aspects. The proposal from 1998 is even worse.
KEY WORDS: privatisation, equality before the law, participation rights, users, providers, ownership transformation