Public provision by the private sector: a four country comparison of emergency ambulance services

Private engagement in public services is well established and the practice of contracting out which started with 'blue collar' services has now extended to a broad range of public provision. (Asher 1987) The 2008 financial... [ view full abstract ]

Private engagement in public services is well established and the practice of contracting out which started with 'blue collar' services has now extended to a broad range of public provision. (Asher 1987) The 2008 financial crisis which was associated with reduced public service budgets in many countries also highlighted the search for both cost savings and service efficiencies. (Pollitt 2010) The focus on consumer approaches and choice also encouraged the growth of individual budgets where people could opt for a preferred supplier and indeed make a meaningful decision about the nature of service which they received. (Le Grand 2009)

However emergency services such as police, fire and rescue have generally remained as public provision and are seen as natural monopolies ( the recipient does not generally choose which fire provider comes in an emergency but rather the provider is determined by the location of the fire.) (Wagner and Weber 1975)

This paper draws on research undertaken globally which examined the provision of emergency medical ( especially ambulance ) response by the private sector in the USA, India, Colombia and in Denmark. The research focused upon the experience of Falck , the largest global company providing this service. The countries were chosen from the 45 countries where Falck operates in order to demonstrate national diversity and to compare a range of forms of private sector engagement. The research was undertaken through fieldwork in each of the countries as well as through documentary analysis and interviews conducted with senior staff of the company. (Murdock 2017 forthcoming)

The paper demonstrates that there is a variety of models of engagement of the private sector in such emergency response. This engagement involves a mixture of the expertise of the company, engagement with local private providers and a diversity of actual service delivery models. The case studies also illustrate both the tensions for a private company in this sensitive area of public provision and also the potential for synergy in the involvement of a private provider.

References
Ascher, K., 1987. The politics of privatisation: contracting out public services. Basingstoke, Hamp., Macmillan.
Le Grand, J., 2009. The other invisible hand: Delivering public services through choice and competition. Princeton University Press.
Murdock , A (2017 forthcoming) Private Provision for Public Purpose Plagrave MacMillan
Pollitt, C., 2010. Cuts and reforms—Public services as we move into a new era. Society and Economy, 32(1), pp.17-31.
Wagner, R.E. and Weber, W.E., 1975. Competition, monopoly, and the organization of government in metropolitan areas. The Journal of Law & Economics, 18(3), pp.661-684.