Abstract

Economic theory predicts that outsourcing public services to private firms reduces costs, but the effect on quality is ambiguous. We explore quality differences between publicly and privately owned ambulances in Stockholm County, Sweden, a setting where patients are as good as randomly assigned to ambulances with different ownership status. We find that private ambulances reduce costs and perform better on contracted measures such as response time, but perform worse on noncontracted measures such as mortality. In fact, a patient has a 1.4 percent higher risk of death within three years if a private ambulance is dispatched (in aggregate, 420 more deaths each year). We also present evidence of the mechanism at work, suggesting that private firms cut costs at the expense of ambulance staff quality.

中文翻译：

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公共和私营公司的质量和效率：来自救护车服务的证据*

摘要

经济理论预测，将公共服务外包给私营公司会降低成本，但对质量的影响是模糊的。我们探讨了瑞典斯德哥尔摩县公共和私有救护车之间的质量差异，在这种情况下，患者被随机分配到具有不同所有权状态的救护车上。我们发现私人救护车降低了成本，并且在响应时间等合同措施方面表现更好，但在死亡率等非合同措施方面表现较差。事实上，如果派遣私人救护车，患者在三年内的死亡风险会高出 1.4%（总计每年增加 420 人死亡）。我们还提供了工作机制的证据，表明私营公司以牺牲救护人员质量为代价来削减成本。