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Privatization is the process of transferring ownership of a business, enterprise, agency, charity or public service from the public sector (the state or government) or common use to the private sector (businesses that operate for a private profit) or to private non-profit organizations. In a broader sense, privatization refers to transfer of any government function to the private sector - including governmental functions like revenue collection and law enforcement. [1]
The term "privatization" has also been used to describe two unrelated transactions. The first is a buyout, by the majority owner, of all shares of a public corporation or holding company's stock, privatizing a publicly traded stock, and often described as private equity. The second is a demutualization of a mutual organization or cooperative to form a joint stock company. [2]
Privatization can be accomplished through various methods, including:
In the United States, the contracting of management and operations to a private provider (outsourcing) has been more common than the sale of utility assets to private companies. No major U.S. city has sold its utility assets in recent decades, although some smaller water utilities have done so. [3]
In the United States, under the Medicare managed care the government pays a managed care organization (MCO) a fixed amount called the "capitated rate" for all medical services received by a beneficiary in a given period. Enrollment in the programs has increased substantially since 1990; in 2002 60% of Medicaid beneficiaries and 12% of Medicare beneficiaries were being treated by MCOs. Private sector involvement in Medicare and Medicaid is not limited to MCOs; private doctors, hospitals, nursing homes provide medical care; reimbursement claims are processed by private intermediaries; and peer review organizations, utilization review committees and accreditation organizations like JCAHO are staffed by private medical personnel. [4]
One of the primary recipients of U.S. outsourcing contracts is Maximus Inc., which administers Medicaid and Medicare, as well as the Children's Health Insurance Program (CHIP), welfare-to-work, child support enforcement, and other government programs. [5]
Homeless shelters and food banks are run by private organizations, who also provide treatment services, operate Head Start programs and work with child welfare agencies. Privatization of welfare system expanded in 1996, when the Aid to Families with Dependent Child (AFDC) program was replaced with the Temporary Aid to Needy Families (TANF) program. Welfare services that are often privatized include workforce development, job training and job placement are often privatized. [4]
There is also some private sector involvement in the public education system including charter schools, Educational Management Organizations (EMOs), and school voucher programs. EMOs are usually for-profit and manage charter schools and sometimes traditional public schools as well. The United States Supreme Court upheld school voucher programs against an Establishment Clause challenge in Zelman v. Simmons-Harris . [4]
In the US, private prison facilities housed 12.3% of all federal prisoners and 5.8% of state prisoners in 2001. Contracts for these private prisons regulate prison conditions and operation, but the nature of running a prison requires a substantial exercise of discretion. Private prisons are more exposed to liability than state run prisons. [4]
Both for-profit and non-profit entities are tasked with various responsibilities related to the US foreign aid budget such as providing emergency humanitarian relief, development assistance, as well as post-conflict reconstruction efforts. Similarly, private entities have started to perform tasks that have traditionally been regarded as falling within the government's diplomatic and military authority like participating in peace negotiations, military training, intelligence gathering and other security services or combat-related missions. Many of the military interrogators at Abu Ghraib prison were provided by a private contractor and lacked formal military training; this was subsequently identified as a contributing factor to detainee abuse at the prison by the Fay report. [6]
The United Nations uses private subcontractors as well, and in some cases, "failed states" have relied on private entities extensively for a range of tasks including building critical infrastructure, managing social services programs and using private military companies during the course of armed conflicts.
The United States Constitution only constrains state action and, with few exceptions, "erects no shield against merely private conduct, however discriminatory or wrongful". [7] [4] Gillian Metzger writes:
Adequately guarding against abuse of public power requires application of constitutional principles to every exercise of state authority, regardless of the formal public or private status of the actor involved: 'It surely cannot be that government, state or federal, is able to evade the most solemn obligations imposed in the Constitution by simply resorting to the corporate form' and thereby transferring operation of government programs to private hands"
Even if private actors cannot be held accountable through the traditional constitutional mechanism, they may be bound by other regulatory or contractual requirements. Tort law might be another avenue of protection, and some may argue that this protection could be even more effective as public agencies and employees usually enjoy some degree of immunity from civil liability. [4] [6]
Historically, governments have at times turned government-run institutions into privately held corporations or simply abolished the publicly run institution in order for privately owned competition to enter and compete in the market in question. However, critics often point out that historical methods of privatization were quite different than modern methods. For example, in the United States in the 19th century, a corporation might be chartered by a public entity, such as a municipality, for a very specific purpose (for example, constructing New York's Central Park) with significant constraints on its purpose, task, and duration. Such a corporation would then often cease to exist after its purpose had been fulfilled. This kind of public-private partnership differs in significant ways from a common modern form, where publicly held services or resources might be handed over to a private company with few stipulations and for an indefinite period of time.
Critics of privatization also charge that lucrative contracts may be given to political allies, relatives or friends of public officials and that subsequently, these contractors may not qualified to do the work and/or may provide less quality to the general public. For example, in 2006 the LA Times reported on this pattern in an article stating that for "Indianapolis, New Orleans, Atlanta and other cities, privatization has been accompanied by corruption scandals, environmental violations and a torrent of customer complaints." [8]
Another criticism of privatization, particularly in regard to municipal services such as water utilities, is that some municipalities have seen unacceptable increases in prices of services while seeing also a decrease in the quality of service and level of maintenance of the utility. For example, in Jacksonville, Florida, a company called United Water Resources owned and operated the municipal water system. After monthly bills increased in 1997 by almost $10 per month, and further requests for rate hikes later as well. The municipality's public utility, JEA, decided to buy the water system for $219 million, projecting that this would actually save customers 25% on monthly bills. [9] On the other hand, publicly managed utilities have occasionally reported trouble as well. The New York Times reported in 2004 that a consortium of citizen's groups had won a suit against the city of Los Angeles to repair 488 miles of sewer lines and conduct other maintenance. [10]
There are several leading factors that contribute to municipal or county governments outsourcing. Economics in the format that governments can operate in a more manageable and effective manner. Public administrations have been criticized for their lack of effective service. The quality of service may be slow and employees may not be held accountable for their responsibilities. The view by the public is that public organizations are not friendly, and removed from high-quality public service, the lack of public relations, and training show in the inability of their personnel to deal with the public.
Privatization is thought to be a valuable policy instrument that leads to a greater good. Privatization of public resources injects new value into public assets and increases the privately held capital base of a country. Governments that implement privatization as part of their reforms use it as a mechanism to pursue a variety of objectives, both macroeconomic and fiscal. Governments undertaking privatization have pursued a variety of objectives. In some cases, privatization is a means of achieving gains in economic efficiency, given the extensive prevalence of poor economic performance of public enterprises in many countries and limited success with their reform. Privatization can also be a mechanism for improving the fiscal position, particularly in cases where governments have been unwilling or unable to continue to finance deficits in the public enterprise sector. [11]
The decision as to whether to transfer ownership or operations of a public water utility to a private firm is complex. Immediate economic questions such as “Won't privatization increase customers’ monthly water bills?” are accompanied by larger and longer-term questions relating to public health, employment, political control, environmental issues, and relations with other city services. [3]
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001.
The public sector, also called the state sector, is the part of the economy composed of both public services and public enterprises. Public sectors include the public goods and governmental services such as the military, law enforcement, infrastructure, public transit, public education, along with health care and those working for the government itself, such as elected officials. The public sector might provide services that a non-payer cannot be excluded from, services which benefit all of society rather than just the individual who uses the service. Public enterprises, or state-owned enterprises, are self-financing commercial enterprises that are under public ownership which provide various private goods and services for sale and usually operate on a commercial basis.
A public–private partnership is a long-term arrangement between a government and private sector institutions. Typically, it involves private capital financing government projects and services up-front, and then drawing revenues from taxpayers and/or users for profit over the course of the PPP contract. Public–private partnerships have been implemented in multiple countries and are primarily used for infrastructure projects. Although they are not necessary, PPPs have been employed for building, equipping, operating and maintaining schools, hospitals, transport systems, and water and sewerage systems.
Maximus Inc. is an American government services company, with global operations in countries including the United States, Australia, Canada, and the United Kingdom. The company contracts with government agencies to provide services to manage and administer government-sponsored programs. Maximus provides administration and other services for Medicaid, Medicare, health care reform, welfare-to-work, and student loan servicing among other government programs. The company is based in Tysons, Virginia, has 34,300 employees and a reported annual revenue of $3.46 billion in fiscal year 2020.
Municipalization is the transfer of private entities, assets, service providers, or corporations to public ownership by a municipality, including a city, county, or public utility district ownership. The transfer may be from private ownership or from other levels of government. It is the opposite of privatization and is different from nationalization. The term municipalization largely refers to the transfer of ownership of utilities from Investor Owned Utilities (IOUs) to public ownership, and operation, by local government whether that be at the city, county or state level. While this is most often applied to electricity it can also refer to solar energy, water, sewer, trash, natural gas or other services.
Dual-eligible beneficiaries refers to those qualifying for both Medicare and Medicaid benefits. In the United States, approximately 9.2 million people are eligible for "dual" status. Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries.
Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.
A concession or concession agreement is a grant of rights, land or property by a government, local authority, corporation, individual or other legal entity.
A public hospital, or government hospital, is a hospital which is government owned and is fully funded by the government and operates solely off the money that is collected from taxpayers to fund healthcare initiatives. In almost all the developed countries but the United States of America, and in most of the developing countries, this type of hospital provides medical care free of charge to patients, covering expenses and wages by government reimbursement.
The Arizona Health Care Cost Containment System is the state agency that administers Arizona's Medicaid program. Medicaid was created to provide healthcare to individuals who qualify by financial need. The $14.6 billion program covers the behavioral and physical health care services for more than 1.9 million Arizonans. In 2019, AHCCCS covers approximately 48% of Arizona's children and 54% of babies born in the state.
The California Medical Assistance Program is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level. Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long-term care and support. Medi-Cal was created in 1965 by the California Medical Assistance Program a few months after the national legislation was passed. Approximately 15.28 million people were enrolled in Medi-Cal as of September 2022, or about 40% of California's population; in most counties, more than half of eligible residents were enrolled as of 2020.
Virginia Health Quality Center (VHQC) was an independent, not-for-profit corporation that primarily focused on health care quality assessment services. Their role was to assess the needs, implement improvements, and evaluate results as it related to how medical care is delivered by health care providers within a targeted geographic area. The VHQC's clients included federal and state agencies, health care providers, managed care organizations, and commercial health insurers in Virginia and throughout the United States.
The Medicare Part D coverage gap was a period of consumer payments for prescription medication costs that lay between the initial coverage limit and the catastrophic coverage threshold when the consumer was a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap was reached after a shared insurer payment - consumer payment for all covered prescription drugs reached a government-set amount, and was left only after the consumer had paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date were re-set to $0 and continued until the maximum amount of the gap was reached or the then current annual period lapses. In calculating whether the maximum amount of gap had been reached, the "True-out-of-pocket" costs (TrOOP) were added together.
In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
Medicare Advantage is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a sponsor a fixed payment. The sponsor then pays for the health care expenses of enrollees. Sponsors are allowed to vary the benefits from those provided by Medicare's Parts A and B as long as they provide the actuarial equivalent of those programs. The sponsors vary from primarily integrated health delivery systems to unions to other types of non profit charities to insurance companies. The largest sponsor is a hybrid: the non profit charity AARP using UnitedHealth.
The United States spends approximately $2.3 trillion on federal and state social programs include cash assistance, health insurance, food assistance, housing subsidies, energy and utilities subsidies, and education and childcare assistance. Similar benefits are sometimes provided by the private sector either through policy mandates or on a voluntary basis. Employer-sponsored health insurance is an example of this.
Medicaid managed care Medicaid and additional services in the United States through an arrangement between a state Medicaid agency and managed care organizations (MCOs) that accept a set payment – "capitation" – for these services. As of 2014, 26 states have contracts with MCOs to deliver long-term care for the elderly and individuals with disabilities. There are two main forms of Medicaid managed care, "risk-based MCOs" and "primary care case management (PCCM)."
James Claude Robinson is a professor of health economics at the University of California, Berkeley School of Public Health, where he has the title of the Leonard D. Schaeffer Endowed Chair in Health Economics and Policy. Robinson is also the Chair of the Berkeley Center for Health Technology, which supports research and professional education projects related to coverage, management, and payment methods for innovative technologies including biopharmaceuticals, medical devices, and diagnostics.
The 340B Drug Pricing Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to "stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services." Maintaining services and lowering medication costs for patients is consistent with the purpose of the program, which is named for the section authorizing it in the Public Health Service Act (PHSA) It was enacted by Congress as part of a larger bill signed into law by President George H. W. Bush.
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