Ohio has privatized a portion of their workers compensation, which is a state monopoly, i.e., if you?re not a self-insured employer you must buy you workers compensation insurance from the Ohio Bureau of Workers Compensation (BWC). About 8 ? 10 years ago they privatized the medical management giving it to private Managed Care Organizations (MCO). How much an MCO is paid is in large part dependent on meeting certain goals, e.g., approving or denying a doctor?s request for treatment within 3 days and getting people back to work. It?s definitely increased the efficiency because BWC can enforce standards for the MCOs that they could never force their employees to meet between their union and civil service. On the other hand, BWC never laid anyone off even though they outsourced 25% to 30% of what they do so the maximum savings has never been realized. The other problem is that they are starting to seriously cutting back the dollars they?re paying to the MCOs because some of the people at the top don?t like the system and are trying to starve it out of existence, which is starting to impact the quality of they?re work. If nothing else, this system pretty well demonstrates that with good oversight you can increase efficiency because you can force contractors to meet standards you can never get governments workers to meet. Privatizing the providing social services as opposed to administering them depends on the services, e.g., I wouldn?t want the police or courts privatized on the other hand Return to Work programs can be privatized. In fact, there is a significant privatized sector of what?s call Vocational Rehabilitation, which is helping people with disabilities back to work including social and psychological disabilities. But it?s absolutely necessary that there be excellent government oversight that is efficient, encourages what is necessary to be successful, and is apolitical and the ladder is often the problem.