Econ Papers Daily / 期刊论文
私营管理下的公共服务
Public Services Under Private Management
摘要
Theory predicts that outsourcing public services to the private sector can reduce costs and improve efficiency, but can also induce cost-cutting and compromise quality. We assess the Brazilian “Organizações Sociais de Saude” model (OSS), which outsources management of public hospital services to the private sector while the state remains the residual claimant. We show that this enhances hospital production and operational efficiency without adverse effects on hospital quality and equity. Increased inpatient production addresses previously unmet demand, expanding local access to hospital care and reducing population mortality. Performance gains arise from improved operational efficiency achieved through increased hospital management capacity. This facilitates staffing adjustments, favoring higher-skilled personnel, dismissing lower-productivity staff, and adopting flexible, performance-tied employment contracts. Effects are larger among private organizations with more management experience, underscoring returns to managerial capacity. Our findings show that incentive-ownership structures can address the quantity-quality trade-off in public service delivery, even when contracts are incomplete and quality is hard to measure.
中文摘要
理论预测，将公共服务外包给私营部门可降低成本并提高效率，但也可能引发成本削减并损害服务质量。我们评估了巴西的"健康社会组织"（OSS）模式——该模式将公立医院管理服务外包给私营部门，而国家仍保留剩余索取权。研究表明，该模式提升了医院产出与运营效率，且未对医院质量与公平性产生负面影响。住院服务量的增加满足了此前未被满足的需求，扩大了当地医院服务的可及性，并降低了人口死亡率。绩效提升源于医院管理能力增强带来的运营效率改善，这促进了人员结构调整——优先雇佣高技能人员、解雇低生产率员工，并采用灵活且与绩效挂钩的雇佣合同。在管理经验更丰富的私营组织中，效果更为显著，凸显了管理能力的回报。我们的发现表明，即使合同不完善且质量难以衡量，激励性所有权结构仍能解决公共服务供给中的数量-质量权衡问题。