Outsourcing public sector activities - How is quality maintained when public health care services are subject to contracting out?

Abstract: In recent years outsourcing of public health care activities has increased in Sweden. Outsourcing of public health care activities involves possibilities of innovation and improvement according to many, but there are difficulties with how to maintain and control quality in the outsourced activities. The focus of this thesis is on how quality is ensured when public activities are subject to contracting out. Contractual relationships do not function in the same way as administrative channels and therefore, as a result of outsourcing, new procedures has to be developed in order to ensure quality. Material connected to the procurement process of health care in Region Skåne and an interview conducted with an official are analyzed in order to examine how quality is ensured. By examining how contracts are specified, monitoring performed and accountability enforced it is clarified how quality is ensured in activities operated by private health care providers with public funding. The results show that quality is regulated in the contracts but that many of the quality measures are intangible. Follow-up of the activities is carried out by patient surveys, reports and meetings with the private health care providers. Accountability is enforced but through different channels than in the public sector. The many difficulties with monitoring and operationalizing health care outcomes contribute to the relatively intangible measures and control of quality. Furthermore, in order to allow for innovation some responsibility has to be left to the provider.