Privatization of Hospital Order Treatment: Patterns, Causes, and Effects in Comparison Across the German Länder

Headed by:
Prof. Dr. Annette Elisabeth Töller
Project Status:

Type of project: University-funded project

Short description

Former state tasks, such as providing the population with transport, energy, telephone, and mail services or collecting and processing waste, have been comprehensively privatized in Germany over the last 20 years. However, the penal system – closely connected to the state’s monopoly on the use of force – has been exempt from this trend, unlike, e.g., in the United States or Great Britain, because it is generally acknowledged as a core area of public tasks that cannot be privatized. However, this resistance to privatization does – surprisingly – not apply to the related field of psychatischer Maßregelvollzug (psychiatric hospital order treatment, HOT), i.e., the mandatory confinement of criminally incapable offenders in forensic psychiatric hospitals to “better and secure” them. This area has been privatized in several German Länder (states) from 2000 onwards. The background of this development is three-fold: The number of offenders confined in such hospitals has increased sharply, the discourse on “security” has intensified since the mid-1990s, and the privatization of hospitals has become a stark trend over the past 10 years.

This research project follows the tradition of research on privatization in political and administrative science and pursues three goals by comparing the Bundesländer (states):

  • The first, descriptive goal is to precisely map the different patterns of privatization in the individual Länder: Which Länder have functionally privatized HOT, i.e., have sold their hospitals to private operators and transferred the task of hospital order treatment to these operators? Which Länder have privatized only “in form” and which do not consider either?
  • The second, explicative goal concerns the explanation of these differences. Why have 5 out of 16 Länder functionally privatized hospital order treatment, while others have not? Which role do the causal factors identified by public policy research play: Institutions, parties, and problem pressure?
  • The third, evaluative goal examined the consequences of privatization. We consider the effects on costs (Do private operators work more efficiently?), on service quality (Does privatization negatively affect treatment quality or security?), and on state control (How does the state try to control privatized services, and does it succeed?)

Publications (in German):

Annette Elisabeth Töller and Marcus Dittrich. 2011. Die Privatisierung des Maßregelvollzugs. Die deutschen Bundesländer im Vergleich. Der moderne Staat (dms), 1, 191-210. Full German version including abstract in English:

Michael Stoiber and Annette Elisabeth Töller. 2016. Ursachen der Privatisierung des Maßregelvol­zugs in Deutschland. Eine QCA im Bundesländervergleich. Zeitschrift für Vergleichende Politikwissenschaft (ZfVP), 1, 1-28.