Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Dwyer, Judith; Boulton, Amohia; Lavoie, Josée G.; Tenbensel, Tim; Cumming, Jacqueline

doi:10.1080/14719037.2013.868507

Cited by 28 publications

(39 citation statements)

References 30 publications

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“…Contracting out is favored under the NPM paradigm because of its ability to draw detailed service specifications and designate sets of goals, deliverables, and performance management indicators to improve quality standards and accountability (Davies ; Dwyer et al ). The primary theoretical gain from contracting out arises from the contestability of the market.…”

Section: Theoretical and Empirical Literaturementioning

confidence: 99%

Cheap and Dirty: The Effect of Contracting Out Cleaning on Efficiency and Effectiveness

Elkomy

Cookson

Jones

2019

Public Administration Review

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Contracting out of public services, especially ancillary services, has been a key feature of New Public Management since the 1980s. By 2014, more than £100 billion of U.K. public services were being contracted out annually to the private sector. A number of high-profile cases have prompted a debate about the value for money that these contracts provide. Value for money comprises both the cost and the quality of the services. This article empirically tests the contestability and quality shading hypotheses of contracting out in the context of cleaning services in the English National Health Service. Additionally, a new hypothesis of coupling is presented and tested: the effect of contracting of ancillary services on patient health outcomes, using the hospital-acquired infection rate as our measure. Using data from 2010-11 to 2013-14 for 130 National Health Service trusts, the study finds that private providers are cheaper but dirtier than their in-house counterparts. Evidence for Practice • Contracting out of public services, especially auxiliary services, is a key component of New PublicManagement because of the belief that it will lower costs and possibly increase quality. • Economic theory predicts that when quality is hard to measure ex-post or hard to define ex-ante, suppliers may reduce quality to maintain their own costs, as they are the residual claimant on any profit. • We find evidence to support the quality shading hypothesis and the coupling theory. Hospitals contracting out cleaning services had lower levels of cleanliness and worse health-care outcomes as measured by hospitalacquired infections. • Public service managers must be very careful when outsourcing services-even auxiliary services; some performance indicators should reflect aspects of the quality of the core service.

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Section: Theoretical and Empirical Literaturementioning

confidence: 99%

Cheap and Dirty: The Effect of Contracting Out Cleaning on Efficiency and Effectiveness

Elkomy

Cookson

Jones

2019

Public Administration Review

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“…This paucity in administration renders certain child populations to be at heightened risk of vaccine‐preventable disease (VPD). Many of these vulnerable populations experience comparatively greater health challenges, including higher rates of notifiable disease, and associated morbidity and mortality 2–9 . This increased risk may be compounded by the social determinants of health and the effects of globalisation 9–11 …”

Section: General Practicementioning

confidence: 99%

Barriers to vaccination service delivery within general practice: opportunity to make a sustainable difference in Aboriginal child health?

Carman

Andrew

Devine

et al. 2019

Australian and New Zealand Journal of Public Health

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Objective: To identify behavioural barriers of service provision within general practice that may be impacting the vaccination coverage rates of Aboriginal children in Perth, Western Australia (WA). Methods:A purposive developed survey was distributed to 316 general practices across Perth and three key informant interviews were conducted using a mixed-methods approach.Results: Of the surveyed participants (n=101), 67.4% were unaware of the low vaccination coverage in Aboriginal children; 64.8% had not received cultural sensitivity training in their workplace and 46.8% reported having inadequate time to follow up overdue child vaccinations. Opportunistic vaccination was not routinely performed by 30.8% of participants. Key themes identified in the interviews were awareness, inclusion and cultural safety. Conclusion:Inadequate awareness of the current rates, in association with a lack of cultural safety training, follow-up and opportunistic practice, may be preventing greater vaccination uptake in Aboriginal children in Perth. Cultural safety is a critical component of the acceptability and accessibility of services; lack of awareness may restrict the development of strategies designed to equitably address low coverage. Implications:The findings of this study provide an opportunity to raise awareness among clinicians in general practice and inform future strategies to equitably deliver targeted vaccination services to Aboriginal children.

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“…Community‐based NGOs – the Aboriginal Community‐Controlled Health Organisations (ACCHOs) – provide a major share of primary health care for Aboriginal people (estimated at between one‐third and one‐half of the Aboriginal population) 2 and are generally recognised as a successful component of the health system. However, there is also widespread concern about the effectiveness of current governance and stewardship arrangements, both by government and in the ACCHO sector 3 …”

Section: Why Focus On Stewardship and Governance?mentioning

confidence: 99%

Legally invisible: stewardship for Aboriginal and Torres Strait Islander health

Howse

Dwyer²

2016

Australian and New Zealand Journal of Public Health

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Objectives: The need to improve access to good health care for Aboriginal and Torres Strait Islander people has been the subject of policy debate for decades, but progress is hampered by complex policy and administrative arrangements and lack of clarity about the responsibilities of governments. This study aimed to identify the current legal basis of those responsibilities and define options available to Australian governments to enact enduring responsibility for Aboriginal health care. Methods: This study used a framework for public health law research and conducted a mapping study to examine the current legal underpinnings for stewardship and governance for Aboriginal health and health care. More than 200 pieces of health legislation were analysed in the context of the common and statutory law and health policy goals. Results: Very little specific recognition of the needs of Aboriginal people was found, and nothing that creates responsibility for stewardship and governance. The continuing absence of a legislative framework to address and protect Aboriginal health can be traced back to the founding doctrine of terra nullius (unoccupied land). Conclusions: We considered the results applying both a human rights perspective and the perspective of therapeutic jurisprudence. We suggest that national law for health stewardship would provide a strong foundation for progress, and should itself be based on recognition of Australia's First Peoples in the Australian Constitution, as is currently proposed.

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Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Cited by 28 publications

References 30 publications

Cheap and Dirty: The Effect of Contracting Out Cleaning on Efficiency and Effectiveness

Cheap and Dirty: The Effect of Contracting Out Cleaning on Efficiency and Effectiveness

Barriers to vaccination service delivery within general practice: opportunity to make a sustainable difference in Aboriginal child health?

Legally invisible: stewardship for Aboriginal and Torres Strait Islander health

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