Is Contracting a Form of privatization?/La Contractualisation Est-Elle Une Forme De privatisation?/La Contratacion: ?Una Forma De Privatizacion?

It is common for contracting to be seen as a form of privatization. When it ceases to provide health services, the state contributes instead to the privatization of the health sector. Contracts are generally seen as the tool that makes privatization possible. Others take the more subtle view that unwillingness to declare the objective of direct privatization accounts for the use, at least initially, of contracting, which enables the private sector to expand its presence within the health sector. By these means (like the Trojan horse), after some time has passed, the private sector will end up occupying the field. But what is privatization? In its accepted meaning, privatization involves a transfer of legal ownership from a public-sector entity to the private sector. Privatization is thus an institutional arrangement rather than a contractual one. However, in the specialized literature on the reform of the state, the concept of privatization has taken on a wider meaning: privatization also encompasses the adoption of a management model that draws on the rules of the market. If we apply the rationale developed by Rondinelli & Iacono, (1) privatization of this sort may be achieved in several ways, as described below. * By transferring ownership: this involves transfer of the ownership of certain public entities (such as hospitals, health centres, laboratories and drug distribution services) to the private sector. This is described by some authors as state "disinvestment." (2) * While preserving public ownership, ensuring that public entities adopt the managerial practices of the private sector. this involves suppression of arbitrary subsidies and public monopoly status, adoption of a status granting autonomy to the entity, the possibility of outsourcing certain non-essential tasks and the use of non-public-sector work contracts. The basis for this approach is the assertion that the administration may no longer be considered as a whole, but that it comprises specific entities which must be able to act independently. * While preserving public-sector ownership, entrusting the management of public entities to the private sector. this is known as delegated management. In such cases it is necessary to address the question of the preservation of the public service mission. * While preserving control over public funding, purchasing services from private providers, regardless of whether they operate from health facilities: the private provider becomes a service provider and is paid for acting as such and for providing the product defined in the contract. * Persuading the private sector to take the place of the public sector, in this case, ownership is and remains private, but the private entity takes the place of the public actor which previously performed the activity. We can thus say that in each of the above situations, the health system will be increasingly privatized because it will operate more in line with the rules of the market. However, the concept of privatization is clearly far more complex than its commonly accepted meaning would imply. It is not simply an action that leads to a new situation, but also an action that leads to a change in behaviour. …