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This article investigates the current use of Public-Private Partnerships (PPP) in the Danish health sector based on an initial discussion of theoretical approaches that analyze PPP. The empirical analysis concludes that PPP has been used very sparsely in the Danish health sector. There are few examples of large-scale partnership projects with joint investment and risk taking, but a number of smaller partnerships such as jointly owned companies at the regional level. When defining PPP more broadly, we can identify a long tradition for various types of collaboration between public and private actors in health care in Denmark. An analysis of the regulatory environment is offered as an explanation for the limited use of PPPs in Denmark. Major political and institutional actors at the central level differ in their enthusiasm for the PPP concept, and the regulatory framework is somewhat uncertain. A number of general issues and concerns related to PPPs are also discussed. It is suggested that a risk-based framework can be useful for mapping the potential and challenges for both private and public partners. Such a framework can be used to feed into game theoretical models of pros and cons for PPP projects. In general terms, it is concluded that more empirical research is needed for the assessment of the various risk factors involved in using PPPs in health care. Most PPPs are still very young, and the evidence on performance and broader governance issues is only just emerging. Ideally, such assessments should include comparisons with a purely public alternative.

The issue of public sector values has been increasingly important in public sector reform debates in Europe in the past decade. While there is much debate over values and normative basis there is limited empirical evidence on value profiles and value changes. This article aims to address such limitations by presenting data from a major survey based study of value orientations at all levels in the Danish public sector. The article investigates the following questions: How do public managers perceive values in the public sector? Can we construct value profiles for the public sector or parts of it? Two related hypotheses are suggested. First that it is possible to identify a set of values that is regarded as important by almost all public managers and second that these value profiles are reflected in value orientations and perceptions regarding staff skills and motivation. [ABSTRACT FROM AUTHOR]

The article investigates the processes driving the ongoing Danish reform of the structure of the public sector with the purpose of understanding the factors rendering the reform possible at this particular juncture in time. For this reason, the article applies a theoretical framework consisting of John Kingdon's ‘Multiple Streams’ perspective combined with the Institutional Rational Choice approach developed by Fritz Scharpf, among others. As a heuristic tool for the analysis, the policy process is divided into the three phases of initiation, estimation and decision making. The analysis points to a rather complex process influenced by institutional and situational factors, including those of coincidence and external events. The process can be understood as a series of interrelated games in which bounded rational actors pursue their interests. In conclusion, the article finds that the speed and tight steering of the process left relatively little room for a broader public and political debate. The process leading to what has become the largest public sector reform in Denmark was in actuality determined by relatively few actors involved in decisive moments. [ABSTRACT FROM AUTHOR]

Background: What is common to many healthcare systems is a discussion about the optimal balance between public and private provision. This paper provides a scoping review of research comparing the performance of public and private hospitals in Europe. The purpose is to summarize and compare research findings and to generate questions for further studies.Methods: The review was based on a methodological approach inspired by the British EPPI-Centre's methodology. This review was broader than review methodologies used by Cochrane and Campbell and included a wider range of methodological designs. The literature search was performed using PubMed, EconLit and Web of Science databases. The search was limited to papers published from 2006 to 2016. The initial searches resulted in 480 studies. The final sample was 24 papers. Of those, 17 discussed economic effects, and seven studies addressed quality.Results: Our review of the 17 studies representing more than 5500 hospitals across Europe showed that public hospitals are most frequently reported as having the best economic performance compared to private not-for-profit (PNFP) and private for-profit (PFP) hospitals. PNFP hospitals are second, while PFP hospitals are least frequently reported as superior. However, a sizeable number of studies did not find significant differences. In terms of quality, the results are mixed, and it is not possible to draw clear conclusions about the superiority of an ownership type. A few studies analyzed patient selection. They indicated that public hospitals tend to treat patients who are slightly older and have lower socioeconomic status, riskier lifestyles and higher levels of co-morbidity and complications than patients treated in private hospitals.Conclusions: The paper points to shortcomings in the available studies and argues that future studies are needed to investigate the relationship between contextual circumstances and performance. A big weakness in many studies addressing economic effects is the failure to control for quality and other operational dimensions, which may have influenced the results. This weakness should also be addressed in future comparative studies. [ABSTRACT FROM AUTHOR]

Abstract The involvement of private for-profit (FP) and not-for-profit (NFP) providers in the otherwise public delivery of welfare services is gradually changing the Nordic welfare state towards a more market-oriented mode of service delivery. This article examines the relationship between ownership and quality of care in public and private FP and NFP nursing homes in Denmark. The analysis draws on original survey data and administrative registry data (quality inspection reports) for the full population of almost 1000 nursing homes in Denmark. Quality is measured in terms of structural quality, process quality and outcome quality. We find that public nursing homes have a higher structural quality (in terms of, for instance, staffing), while FP providers perform better in terms of process quality (e.g. in the form of individualised care). NFP providers perform well in terms of structural criteria such as employment of full-time staff and receive fewer critical comments in the inspection reports. However, the results depend to some extent upon the method of data collection, which underlines the benefits of using multiple data sources to examine the relationship between ownership and the quality of care. Highlights • The article analyzes quality differences between public and private nursing homes. • Overall, ownership is not significantly associated with quality differences. • Public nursing homes perform, however, better on some dimensions of structural quality. • Private for-profit nursing homes perform better on some dimensions of process quality. • Non-profit nursing homes receive fewer critical comments in official inspection reports. [ABSTRACT FROM AUTHOR]