PUBLIC OR PRIVATE SERVICE DELIVERY? EMPLOYEES’ ATTITUDES TO END-OF-LIFE CARE IN SIX EU COUNTRIES

AbstractWhy should there be a distinction between public or private funded long term care for people at the end of their life? The conventional wisdom and the study of public administration is based on the belief that public and private organizations differ significantly. This paper argues that this statement is more a myth than a fact. Notwithstanding the number of public-private comparisons, comparative cross-country studies on employees’ behavior and attitudes towards end-of-life care for older people are neglected in this area. This paper aims to explore similarities and differences between care staffs’ behavior and attitudes towards end-of-life care for older people in public and private long term care facilities (LTCF) in six European countries: Belgium, Finland, Italy, the Netherlands, Poland and United Kingdom. As part of PACE project (“Comparing the Effectiveness of Palliative Care for Elderly People in Long Term Care Facilities in Europe” funded by the EU 7th Framework Programme), the survey data were collected in 2015 by recruiting a random sample of LTCFs in six countries. The results indicate more similarities than differences. Possible explanations between the sectors are explored, and the strengths and limitations of the study are discussed. Findings contribute in particular to the literature on public service motivation and public values and our understanding of how both public and private LTCFs serve public good. As a conclusion the paper suggests that service delivery as a public/private service issue should be taken more seriously: care staff prefer to care older people as human beings.