School health services in the Southern District of Israel-between privatization and nationalization.

IF 3.5 4区 医学 Q1 HEALTH POLICY & SERVICES
Tzion Dadon, Ya'akov M Bayer, Anat Rosenthal, Michael Gdalevich
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Abstract

Background: For decades, Israel's economic policy has favored either outsourcing or privatization of public services, including healthcare, generating an ongoing and prolonged debate of this approach. In 1997 school health services (SHS) for elementary and middle school pupils was outsourced to a sub-contractor firm, reducing budget, but also standards, for nurses and physicians. Consequently, the service has dwindled and was focused more and more on vaccinations. Between 2007 and 2012, under full private contractor delivery, SHS quality diminished substantially, leading to a significant decline in vaccination coverage in the Southern District. In 2012, a decision was made to return SHS to state control.

Methods: This study analyzes the delivery parameters of SHS between the period when the service was operated by a private contractor from 2011to 2/2012, and the subsequent provision of the service directly by Ministry of Health (MoH) between 3/2012 and 2013. We compared the rates of vaccination coverage, screening tests and health education programs.

Results: A statistically significant increase in SHS delivery for vaccinations and screening was observed in the Southern District of MoH after the transfer of service from contractor. The increase was variable in different population subgroups, and especially notable in the Bedouin schools of the District, where the MMRV vaccination rose from 19.3% to 96.8%. However, a substantial and significant reduction in health education activities was also noted, overall from 24.9% to 5.0%.

Conclusions: The findings suggest that substantial benefits can be derived from direct provision of SHS by MoH and its regional offices, especially in the areas of reduced accessibility and lower socio-economic status. The case study of SHS in the Southern District of Israel can serve as an important example highlighting the impacts of privatization vs nationalization, with potential implications in other fields. These insights should be integral to future discussions of healthcare service provision.

以色列南部地区的学校卫生服务--私有化与国有化之间。
背景:几十年来,以色列的经济政策一直倾向于将包括医疗保健在内的公共服务外包或私有化,从而引发了对这一做法的持续和长期的争论。1997 年,为中小学生提供的学校保健服务(SHS)被外包给一家分包商公司,不仅减少了预算,还降低了护士和医生的标准。因此,学校保健服务逐渐减少,并越来越侧重于疫苗接种。2007 年至 2012 年期间,在完全由私人承包商提供服务的情况下,社会医疗服务质量大幅下降,导致南区的疫苗接种覆盖率显著下降。2012 年,政府决定将社会卫生保健服务交还国家控制:本研究分析了 2011 年至 2012 年 2 月由私人承包商运营期间,以及 2012 年 3 月至 2013 年由卫生部直接提供服务期间的社会卫生保健服务参数。我们比较了疫苗接种覆盖率、筛查测试和健康教育计划:结果:从承包商手中接过服务后,卫生部南区的疫苗接种和筛查服务在统计上有了明显增加。不同人群的增长情况各不相同,尤其是在该地区的贝都因学校,麻腮风疫苗接种率从 19.3%上升到 96.8%。然而,健康教育活动也显著减少,从 24.9% 减少到 5.0%:研究结果表明,由卫生部及其地区办事处直接提供社会卫生服务可以带来巨大的效益,尤其是在交通不便和社会经济地位较低的地区。以色列南区社会科学及人文科学部门的案例研究可以作为一个重要实例,突出私有化与国有化的影响,并对其他领域产生潜在影响。这些见解应成为今后讨论医疗保健服务提供的组成部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.20
自引率
4.40%
发文量
38
审稿时长
28 weeks
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