'When and where is private healthcare more effective than publicly funded healthcare?' That is a good question to ask, as we head into a recession.

I find that almost all private healthcare providers will claim that they are 15%-25% more effective and deliver better quality of care than the public sector. But they would say that, wouldn’t they?

Can this be true? If so, how do you prove it?

The trouble is that objective attempts to compare delivery are few and far between. As a general rule, most academics are anti-private healthcare. And, in fact, I have yet to find any objective assessment of these claims.

This is curious, given the number of examples. First, we have the Alzira model in Spain, where the private sector, led by healthcare insurer Adeslas, took over the running of primary and secondary healthcare for an entire district of 250,000 people in the late 1990s.

You can find a fascinating document, in English, on how it works with the state and the public health authorities by clicking here and browsing the corporate responsibility document put out by Agbar, the big Spanish water utility which owns 55% of Adeslas (the rest is held by French mutual insurer Médéric).

Just search the document for Adeslas. This claims that Alzira is 25% cheaper than public provision, and has slashed waiting lists. There is a lot in here about how it works transparently with the public health authorities in Alzira and around Spain.

Then we have the huge shift towards outsourcing in Sweden, where up to 50% of the primary sector could pass into private sector management within the next five years.

Another interesting experiment is the outsourcing of Greek hospital Errikos Dynan in Athens to Eurohospital, a 50/50 joint venture between two big private groups, Athens Medical and Euromedica. Here, at least, we should get some feedback, as the Greek government is committed to saying how the experiment has gone early in 2009, at the end of the first year.

It is certainly a question which bears answering, particularly in Germany, where it looks as if we are in for yet another cycle of privatisation, as German municipalities and Laender look to sell off unprofitable hospitals. We hear that Rhoen Klinikum is in acquisition talks with no fewer than six groups!

At the very least, it would be good to know that privatisation doesn’t damage the delivery of healthcare. Yet, if Alzira really is 25% better and higher quality, why does it remain a solitary experiment?