Policy issues in the private health sector: examples from long-term care in the U.K

The international trend towards private markets in health care can be illustrated very clearly by developments over the last decade in the U.K., where the balance of health care provision has shifted from a predominantly free, public and comprehensive system to more of a mixed economy model. The shift can be attributed to a variety of factors, and not government policy alone. The relationship between the private and NHS sectors of health care is not a simple one and there are both positive and negative implications of the public-private mix. The growth of private hospitals and acute beds has dominated debates about private health care, but further policy issues have emerged in relation to the significant growth in private residential and nursing home care. This paper briefly reviews developments in private health care and then explores the key policy issues associated with this development. Secondly, an analysis of developments in the private residential care sector is undertaken highlighting the relationship between the public and private sectors of care provision. Policy issues pertaining to the long-term care sector of private health care are raised, including the regulation of residential care, regulatory models, enforcement and quality, and standards of care. Lessons for the regulation of private health care generally are considered and the implications for the private sector of a growing trend towards market deregulation are explored. Future models of long-term care are discussed and the likely balance between the public and private sectors explored.