Loening, Matthias Maria
(2009)
Ownership, efficiency and quality: A comparison between national health service and independent sector treatment centres in England.
PhD thesis, London School of Economics and Political Science.
Abstract
The Treatment Centre (TCs) Programme in England has been put forward as part of a government strategy to add capacity, to improve quality and access to care to NHS patients and to provide competitive incentives to improve quality within the NHS. At present, two types of TCs are being rolled out; the Independent Sector Treatment Centres (ISTCs), managed by the private sector, and the NHS Treatment Centres (NHS TCs), managed by the National Health Service (NHS). This dissertation focuses on a number of important questions raised by the increase in the number of these Treatment Centres in England. Are there differences between the ISTCs and NHS TCs in terms of efficiency. Are there differences between the ISTCs and NHS TCs in terms of quality. Are there differences in the organisational, managerial and technological approach between the Independent Sector Treatment Centres and the NHS Treatment Centres. And how does the difference in their ownership structure relate to any differences in performance and approach found between the ISTCs and NHS TCs. A quantitative and qualitative research methodology is used. Basic descriptive analysis, weighted mean difference and regression analyses are conducted for the quantitative approach using Dr. Fosters 2007 patient record information. The purpose of the quantitative analysis is to establish whether there are quantifiable differences in performance between the Treatment Centres in terms of efficiency and quality. The qualitative analysis is designed to open the 'black box' of the quantitative results and to investigate in depth the nature of the underlying relationships revealed by the quantitative analysis. It uses a comparative case study design as the primary approach with interviews and site visits to 18 different treatment centres and hospitals. The quantitative evidence suggests that ownership may play an important role in facility performance. The qualitative evidence shows that there are differences in the actual organisational structure and operations of these treatment centres which affect performance and suggests that ownership is indeed the determining factor for these differences, although due to the methodological approach of the dissertation, the evidence cannot be entirely conclusive in how and to what extent this links back to differences in the quantitative evidence.
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