private education literature review

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Original research article, factors influencing the choice of private or public schools: evidence from georgia.

• 1 Faculty of Arts and Science, Ilia State University, Tbilisi, Georgia
• 2 Department of Sociology, University of California, Berkeley, Berkeley, CA, United States
• 3 Department of Sociology, Czech University of Life Sciences, Prague, Czechia

The existence and development of public schools is influenced by a plethora of factors. Through the creation of education policies, any state education system is striving to accomplish specific goals. Both informal and formal private schooling is taking the lead in all cultures and societies. Unmistakably, the distinction between private and public schools is evident. However, given the different circumstances, choosing the best alternative for a child is regularly a fervently discussed topic among parents. There is no universal answer to the question whether private schools are actually better than or superior to the public schools. Our research aimed to describe the school choice process, it focuses on unveiling the factors and their interrelation while the parent choosing between two types of schools—private and public. First of all, the research aims to describe the parent’s perception of achieving success at school, what is the base for such belief, what the sentence—“School—base of future success” actually mean. How important is so called social index? The significance of the reputation and prestige of the educational institution during school choice process—as a guarantee for future success. The key questions for the research were as follows: (1) How interested the parents are to be actively involved in school choice process and spend certain period of time for that? (2) What factors are considered by the parents during school choice and what is the source they receive information from? (3) Does the family’s socioeconomic condition and the kids gender have influence on the process? It’s worth mentioning that, generally the research results fully coincide with the school choice theory arguments and the research findings conducted in the similar field. All these are described and presented in the first part of the article. The probabilities listed on the base of the current data, that the information source, the parent’s information level, the parents’ engagement as well as the family’s socioeconomic and demographic status play integral role in the school choice process appeared to be genuine. Apparently, the parents are much interested to provide perfect future for their kids, though socioeconomic conditions, environment, poor educational system limits their choice. Once our results compared to the existing literature and theory, one can see that our study conducted in Georgia follows the trends of the developed countries, known as the “Heyneman-Loxley effect.”

Literature review

Based on its multifactorial character, the school selection process is a popular issue of research and attracts the attention of various researchers and educational theorists. For instance, Fowler stated that choosing a school can easily be the most controversial education policy issue of any time ( Fowler, 2002 ).

Generally, the discussion issues are following: should the parent be given freedom during the school choice process, if yes, what is the maximum level of interference, as well as should the government support the increased competition in the education sphere, if yes, give the hints how? The first part of the literature review will cover the Q & A regarding the abovementioned issues, later specifically the selection/choice process and the factors influencing the process itself will be discussed.

Private and public schools

The scholars attempt to outline private education as accurately as possible. Lewis and Patrinos (2012) identify three characteristics distinguishing private education from the public education: funding, sponsorship, and management/control.

The meaning of the term “public” and “private” has changed through years. Its meaning may vary from country to country. Private schools are often state-funded. For instance, charter schools in the US are the best examples. Georgia has a voucher system that implies that the private sector receives these vouchers additionally to extra payment from parents. Therefore, it is difficult to come up with a particular definition for private schools.

In developing countries, the private education system is a guarantor of academic and social security. Since the state fails to provide primary education for all, in some countries, private education is the only way to get quality education, filling the gap left by the state education system.

Many scholars focus on identifying the difference between the private and the public schools. They all undoubtedly agree that public and private schools are significantly different in terms of environment and management. “The private school is characterized by several factors and characteristics, admittedly associated with efficiency, they belong to different sectors of the market and policy controls, they vary in terms of a social control method: state schools represent a hierarchical system of subordination that is structured by democratic politics, while private schools have a wider degree of autonomy, controlled by the market demand and delivery mechanism” ( Chubb and Moe, 1988 ).

Freedom in school selection/Choice process

According to John Stuart Mill “the objections which are urged with reason against state education don’t apply to the enforcement of education by the state, but to the state taking upon itself to direct that education…. All that has been said of the importance of individuality of character, and diversity in opinions and modes of conduct, involves, as of the same unspeakable importance, diversity of educations” ( Allison, 2015 ). 1

Mill’s “Diversity of Education” idea came to spotlight together with the opportunity to develop the school selection/choice right, that happened in Anglo-Saxon reality.

Friedman’s (1955) proposed idea of educational vouchers, which would encourage the introduction of competition in the education, inspired the new theoretical course to be established giving the base to the innovation reformation policy in USA and then in the whole world.

Generally, in reforming states and not only there, there is rising tendency of the parents’ distrust toward public schools, meaning that they will fail to meet their kids demands and goals (it is no surprise that parents are scrambling for enrollment in the limited functional sub-system; Blake and Mestry, 2021 ). Many parents doubt the government’s dedication for providing the educational system with the appropriate standards.

School selection/choice right is an issue of enduring discussion. According to Goodwin (2009) the arguments named by the opponents of the choice can be listed as follows: (a) The excising market is poor in managing certain issues; (b) The choice in education necessarily has deleterious effects on social justice. It underlines and deepens the excising inequality; (c) The choice is not an effective tool for increasing the standard. Thus, out of the above listed three opinions, the very first is an ideological argument in general, so in this particular article we will focus on the rest two issues.

According to the choice proponents the school selection/choice process is equal to other similar decisions, which the parents make on the base of the conditions created by the market, thus the parent, as a consumer should have freedom of choice and right either. At the same time the choice proponents are focusing not only on the parents’ rights of freedom of choice, but they assure that the freedom of choice is ultimate stimuli for the schools’ improvement ( Davies and Aurini, 2011 , p. 460).

Besides this, the parents are well aware of their kids knowing their strength and weakness, as well as their interests and demands. Thus they appear to be the best of the best choice and decision makers. In parallel with this, if the government provides the selection/choice process funding, the poor (not well-off) families will also have opportunity to select the school they favor ( Friedman and Friedman, 1980 ).

According to minor chance of choosing in the traditional schooling system too, though only rich families, who either can pay the private school fee, or move closer to the better school, can afford this. Thus only reformed system, when there is a public funding for providing freedom of choice, can give chance to the poor (not well-off) families to make a choice.

Providing school selection/choice can be the merit of the following: by extending the variety of school types, by expanding the publicly available information about schools, and by expanding the parental capabilities to choose ( Davies and Aurini, 2011 , p. 460).

The following ideas can be used to provide the appropriate public funding for school choice: opening catchment programs, the creation of specialty schools within the public school boards, partial funding of independent schools, charter schools, voucher programs, laws that facilitate home-schooling, and tax credits for private school tuition.

All the above listed initiatives were vast popular in USA during last decades of the twentieth century and later the similar tendency was spread in other countries too ( Belfield and Levin, 2002 ; Merrifield, 2008 ; Hess, 2009 , e.g., Hepburn, 2001 ; Robson and Hepburn, 2002 ; Davies and Aurini, 2011 ).

The reform launched in the last decade of the twentieth century made it clear that the school choice right will reduce the bureaucratic control, decentralization and will improve the schooling system in general ( Clune, 1993 ).

Compering educational pluralism 2 with uniformity, the current mechanisms in use (tax credits, vouchers, scholarships) Berner (2016) concluded that “[pluralism] is more intellectually honest and democratically aligned … and schools with distinctive missions often produce better academic and civic outcomes for students.”

Generally, school choice includes 2 aspects: (a) Policy or regulation defining the equality of power for private and public schools; (b) Public funding, providing the parent’s freedom of choice on behalf of both for public or private schools ( Robershaw et al., 2022 ).

In theoretical literature, during discussing the schools’ choice issue the focus is made on the following three factors: (a) School choice results, which are generally measured on the base of the students’ evaluation; (b) The schools provide the delivery of quality education, meaning how the school responds the market demand; (c) During the selection/choice which aspects are the vast priority for the parents, and how they behave; We focuses exactly on these issues.

School choice process by the parents

When we are discussing the parents’ role in the school choice process, 2 fundamental questions should be asked: (1) Are the parents motivated enough to participate in the process and use all the chances existing on the market? (2) What are the key issues the parents pay the most attention during the choosing process? In other words, 2 things should be clear while talking about the parents: (1) What they demand from the school; (2) Are they capable enough to evaluate each school quality and make rational decision for their kids during the school choice process, or will the government be the better variant for that.

The school choice proponents assume that the most parents desire school variety, are primarily motivated to seek academic quality, and will use available information on achievement when selecting schools. Opponents doubt these assumptions, countering that many parents are more interested in a school’s exclusiveness rather than its pedagogical quality, and that parents use criteria other than test scores when selecting the schools ( Davies and Aurini, 2011 ).

The school choosing proponents stress the revitalization of public education through the creation of private alternatives, thus enhancing parental involvement, satisfaction, empowerment, and sense of community, and resulting in improved student achievement ( Chubb and Moe, 1988 ; Driscoll and Kerchner, 1999 ; Smrekar and Goldring, 1999 ).

According to them this system prepares a solid base for competition between the schools as a result of which the schools appear to be more responsive to the needs and interests of parents and students by providing different types of programs for different types of families ( Bosetti, 2007 ). Thus, on the one hand the individual demands from the students and their parents, and on the other hand the high competition between the schools should make the educational institutions to be attentive toward their clients (parents and students) demands, to attract more students which mean more funds as well.

Though according to the opponents, if the parents don’t have desire or initiative to participate in the school choice process, the choosing system will fail to work and will never become the alternative of the traditional public school. On the other hand, the public schools own more formal and familiar tools and mechanism, which theoretically should help the parents in decision-making. The critics also underline that during the school choosing “parents are able to select their own vision of the ‘good life’ without considering the social goals. This could lead to a loss of diversity and educationally sound public schools and democratic values” ( Erickson, 2017 ).

At the same time “school choice may result in the creation of value communities that reflect ‘little fiefdoms’ that cater to the needs, values, and interests of particular groups. This contributes to the further social fragmentation of society and a two-tier education system” ( Gewirtz et al., 1995 ; Fuller et al., 1996 ). And this prioritizes the well-off middle class of the society, who owns social and cultural capital for gaining the appropriate information ( Bosetti, 2007 ). For defining the social capital, let’s use Bourdieu’s explanation: “Social capital is the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance and recognition [.]” ( Bourdieu, 1986 ). In our case, the parents’ social capital is defined they their own circle/environment, who helps them to have access to the appropriate information for making proper decision ( Corcoran and Jennings, 2020 ).

To its end, the family’s cultural capital is “knowledge and skills acquired over time, through ‘socialization and education that exist within us,’ ‘material objects or cultural goods,’ and ‘institutional acceptance or recognition in the form of academic qualification and credentials”’ ( Bourdieu, 1986 ). Frequently the family’s socioeconomic status is defined as the best indicator for outlining the family’s cultural capital ( Robershaw et al., 2022 ). When we are talking about the maintaining the existing social configuration and deepening the segregation danger while school choice process, Gorard, Fitz research is worth mentioning. The research results showed that, in 1988 the fulfillment of the Education Reform Act 3 didn’t cause any of the above listed results in the schools of England and Wales. According to Bosetti (2004) rational choice theory suggests that parents are utility maximizers who make decisions from clear value preferences, and that they can be relied upon to pursue the best interests of their children.

At the same time, the theory says that they are able to demand effective action from local schools and teachers. Though the modern researches show that rational choice theory is totally useless to explain the school choice process from the parents ( Jabbar and Lenhoff, 2020 ).

The rational choice model totally rejects the importance of the parent’s social network, the fact how the preferences of the different groups vary or what harm can the lack of information bring during the school choice process ( Levin, 2009 ).

One of the approaches used for studying the school choice is the Cultural-Historical Activity Theory (CHAT) described by Engeström in 2001. 4 In case of studying the school choice this covers multiple factors, which may influence each and every individual during his/her school choice process.

It’s worth considering that each and every individual’s approach and interpretation regarding the school choice goals and objectives, at least slightly differ. According to Sullo (2011) “choice theory posits that an individual’s behavior or choices they make are driven by a never-ending quest to satisfy five genetically driven needs and four fundamental psychological needs” ( Blake and Mestry, 2021 ). The critics frequently say that during the school choice process, the parents may prioritize their choice due to convenience or considering certain build-in activities including sports over the schools’ academic level ( Harris and Larsen, 2015 ). According to Erickson (2017) , its beyond sophisticated to measure the academic level. It’s even more sophisticated, to define its real meaning as it includes exams results, teachers’ quality, educational environments and infrastructure, as well as educational programs. He also underlines that, generally it’s not fair the parents to pay key attention only to the academic level as the families’ demands and goals differ.

What factors influence the school choice

Generally, the school choice is quite a complex issue and is the mix of religion, practical demands and opportunities correspondingly. It’s widely spread that those who believe in the vast necessity of freedom of choice, they use this opportunity/right. Would-be choosers are seen to want more input into school decisions, more responsive educators, and more transparent information about school performance. Furthermore, choice is seen to be particularly popular among parents who are deeply involved in their children’s schooling ( Davies and Aurini, 2011 ).

In the developing states, the parents progressively acknowledge the increased value of the education for their kids’ future and for creating priceless opportunities in their lives. Thus, this doubtlessly upsurges the school choice process significance. It’s noteworthy that those parents who are actively involved in the school choice process, are also actively engaged in their kids’ education progression and appear happier with the school compared with those, who absolutely are not involved in the procedure ( Bosetti, 2007 ). Lee et al. (2021) were researching the interdependency of quality and choice. On the base of the research they identified three conclusions: (a) The parents are happier when there is an opportunity to choose confirming that this makes the process much more fair; (b) Though later evolution of the selection objects (in case of experiment till 8) did not have any influence either on satisfaction quality or on the fairness level; (c) Whether performance declines or increases does not affect the effect of provider choice on satisfaction, and, by itself, performance decline lowers satisfaction and perceptions of fairness, consistent with what would be expected from the findings of previous research on public service performance outcomes and satisfaction.

According to Coleman et al. (1982) when a person has to make an important decision, he/she starts to gather information regarding the issue. The situation is all the same with the parent, who has to make choice about his/her kid’s school. During the decision-making process the parent considers his/her personal values and the subjective perception of the existing educational system. The appropriate information is gathered through the parent’s social and professional circle/environment. Thus, it’s logical that those parents who have limited access to valuable and relevant information have trouble to make well-informed choice ( Smrekar and Goldring, 1999 ). Social-economic factors play integral role in the selection/choice process, to be more precise, meaning the parents’ education level and income ( Bosetti, 2007 ). Many scholars mention that the level for having chance to make informed choice depends on the family’s socioeconomic and demographic parameters.

To be more precise, socioeconomic status is seen to provide the knowledge and finances needed to engage in choice, while dominant racial and ethnic groups are seen to be motivated to segregate themselves from minorities (for a review, see Lauen, 2007 ).

Davies and Aurini (2011) researches show that: (a) The majority of Canadian parents support the freedom of choice right; (b) The using of the right of choice depends on socioeconomic and demographic indicators—in reality the parents with higher education use the right of choice more actively. At the same time, less educated parents, as well as ethnic minorities, express eagerness to support the freedom of choice, this means that they would use the chance if they had the opportunity. (c) Third, a mix of educational attitudes predicted choosing; the most consistent was that parents with higher levels of participation in their children’s schooling tended to do more choosing ( Davies and Aurini, 2011 , p. 472).

According to Bosetti (2007) research the educated, employed parents with high income are more active in using the right of choice. At the same time the researches show that the families with high income prefer private schools ( Bosetti and Pyryt, 2007 ) and in case of need, they are ready to move to the expensive districts to live in ( Goyette, 2008 ).

Bosetti (2007) research also showed the role of family condition in school choice process, mainly in case of religious private schools. The vast majority of parents interviewed, indicated that they are married, with religious private school parents being most likely to be married (95%). It’s quite interesting that the parents of the alternative and secular private schools, in frequent cases appear to be divorced or single parents. It’s also worth mentioning that, the parents of the private religious schools’ students own similar or lower socioeconomic status compared with the parents of the public schools’ students’ ( Bosetti, 2007 ). All abovementioned indicate that while religious school choice the parents prioritize the values and they are ready to pay ‘certain price’ for their kids’ future.

It should also be considered that the parents’ socioeconomic status also defines their perception regarding the importance of education. Hatcher (1998) explains that “working-class young people can maintain their class position, and even achieve some upward mobility, simply by completing compulsory secondary education,” when middle-class families are more anxious about the educational options for their children because the benefits of attaining certain educational qualifications and credentials are higher, and the risk of social demotion greater. Therefore, because of these perceived high stakes, middle-class parents are more likely to be predisposed to engage in education markets ( Bosetti, 2007 ).

Some scholars think that, while analyzing school choice, the kid’s gender should also be discussed as one of the integral factors. According to them, the parents have different approaches toward daughters’ and sons’ education. Bellani and Ortiz-Gersavi (2022) research shows that in Italy, for the low income families “parental time preferences matter more for sons than for daughters of lowly educated parents. This gender effect is found both for upper secondary choices and for entry into higher education.” They explain this with different expectations linked to their children. The parents think that sons have higher chance for the career promotion compared with daughters, who should mainly focus on building good family. Such different expectation becomes base for different attitude while school choice. Sahoo (2017) shares similar tendencies though on the example of India. According to his research and analysis households choose to provide their sons rather than daughters with an education which is more expensive and which they perceive to be better in quality. Such attitude is unveiled while selecting the school type—if the family has to choose, which kid should get private (high quality) education, in major cases they send sons to the private schools, as for the daughters, they are sent to public (lower education quality) schools. As it was underlined above for several times, the valuable info gained about the school appears to be one of the main factors for the parent to make final decision. Key sources for the information gathering are friends, neighbors, other parents, as well as teachers, school administration staff who share valuable info to the parents before they make any choice. This once again underlines the importance of the social-cultural role while making final decision from the parent. Thus because of this, the school choice theory opponents assure that, the parents with lower socioeconomic status have limited access to the useful and adequate info. Hence, they are lack of motivation to reserve themselves from sending kids to the neighboring schools, meaning that they won’t spend much time and energy to seek for better options. As a result of this, according to Bosetti (2007) research, nearly half of the public schools’ student’s parents choose the schools before having appropriate information about the certain institution, and this basically exceeds the data regarding the alternative and private schools (21 and 7%, respectively).

Thus, to sum up Bosetti (2007) research results, for the private secular schools’ parents, the most important factors are the class size, values, teaching style and academic reputation; in case of private religious schools—the most important are values and academic reputation; as for the family/public schools—the most significant factor is closeness to house, then comes academic reputation, teachers’ qualification and teaching style.

To keep it simple, the private schools’ students’ parents do their best to choose school based on their kids’ individualism and demands; though public schools’ students’ parents simply accept the existing reality; only exceptions are the lower class religious parents, for whom religion is much important and they are ready to make certain commitments above their power and provide proper education for their kids in private religious schools.

Sending kids in public schools in frequent cases is the result of limited alternatives or just limited access to the information (parents just don’t have info about other educational facilities). As a rule, the parents of the public schools’ kids, state that if the government provide funding, they would have sent their kids to the private schools with the great pleasure ( Bosetti, 2007 ).

According to Blake and Mestry (2021) , in frequent cases the parents have utopic expectations as a result of which they fail to make proper decision. This happens when the parent is lack of proper knowledge/experience regarding educational system or has limited financial condition.

It’s obvious that the family’s financial condition influences the freedom of choice, vividly showing the government’s policy to support the school selection/choice principle to be fair and right, because “without tuition vouchers or bursaries the competitive market pressures generated by these parents is restricted to charter schools or alternative schools in the public education system.” This once again shows that while making school choice, the parents personal attitude is vast important, as according to it, the parents make clear what kind of education, skills and values should their kids’ elaborate during their years at school ( Wells, 2000 ).

As a rule, the parents agree that the key function of the school is to deliver academic knowledge, good working skills, self-discipline, and critical thinking to the kids, though different groups of parents differently prioritize those characters.

To sum up, the parents’ final decision regarding the school choice is defined by following factors: family characters (socioeconomic status, education, income etc.); other demographic characters—kid’s educational demands; Parent’s knowledge of system/appropriate information (exciting school types, exciting school choice programs/policy, and opportunities); Parental perspective of school choice (exciting school types, exciting school choice programs/policy, and opportunities) ( Robershaw et al., 2022 ).

Erickson (2017) underlines three patterns in literature: (1) There is great consistency in parents’ stated preferences of school characteristics across choice programs; (2) Parents value academic quality, but it is not always their most prized school feature; (3) Parents make trade-offs among their preferences when selecting a school.”

According to Fowler (2002) “School choice is going to continue to expand whether we like it or not. Parents like the idea of being able to select their children’s schools, and public support for the idea has grown enormously over the last decade or so.”

It is common knowledge that providing education is a parent’s responsibility, and a parent tries to create the best learning environment for a child. It is the parent’s responsibility to take care of a child’s health, safety, development, and success. Below is listed literature that identifies ten key factors affecting parental decision-making regarding the school type selection: (1) parental social status; (2) income; (3) school syllabus; (4) school environment/infrastructure; (5) school achievement/location; (6) location; (7) qualification of teachers; (8) school image/reputation; (9) the role of religion or moral values in school choice; (10) social selection and social experience for children.

The Heyneman-Loxley effect

According to the study of Heyneman and Loxley (1983) , the family and school impact on students’ academic achievement is highly depended on the degree of economic development of a country/community. Socioeconomic status (SAS- socioeconomic status). While the family impact is more significant in developed countries, school resources and quality of school education is a more reliable determinant for low-income countries.

The research has also shown that when it comes to the mathematics and science, high-income countries have higher academic achievements compared with low-income countries. This finding has been named the “Heyneman-Loxley Effect.” To explain it briefly, Heyneman and Loxley developed a theory in which family characteristics correlated with school characteristics and student achievement rates.

This case was later explained by Baker et al. (2002) as follows: Education policy in the developed countries and existing areas provide a certain degree of public schooling, creating the environment where the distinction between public and private schools is not so significant. What we are left with is a family socioeconomic condition as a key distinctive feature. In less-developed countries, a uniform minimum standard of schooling does not exist, and therefore, a school factor may turn out to be a decisive determinant, exceeding the quantity of family factors.

After the study referenced above, no study has been carried out in various countries utilizing the same standard until 1990. There was just one—we would be able to generate results and compare the data. Since 1990, this has changed with single-standard international studies that were conducted in different countries (TIMSS, PISA). However, the research conducted under the auspices of TIMSS (1994) , considered a minimal number of the family characteristics—such as mothers’ and fathers’ education and the number of books in the family. The research analysis led in 1994 failed to prove the “Heyneman—Loxley effect.” Yes, there were existing differences, but not significant enough in terms of variables. A 21-year-old analysis showed that among three factors—school quality, family socioeconomic status, and student academic achievement, are not interrelated with the country’s economic performance as described above—the authors conclude that the “Heyneman-Loxley effect” either did not exist or it has undergone the transformation during 21 years. One of the objectives of our research/study is to check the abovementioned conclusion’s accuracy in case of Georgia, as an example country.

Development of education system in Georgia

Prior to the Proclamation of the First Republic on May 26, 1918, Georgia was a part of Tsarist Russia and the school system was governed by the rules of the Russian Empire. The gradual subjugation of the Georgian kingdoms by the Russian Empire (first half of the nineteenth century) coincided with an ongoing school reform in the empire.

A fundamental educational reform, prepared by the closest associates of Tsar Alexander I (1777--1825), created a hierarchical school system headed by the Ministry of Public Education and regulated by The Charter of the Universities of the Russian Empire (1803). It included six educational regions with four types of institutions beyond elementary schools: parish schools, uyezd (district) schools, gymnasiums , and universities. Russian education evolved with both minor and major changes. In 1828 the course of study at gymnasiums was extended to 7 years, with priority given to classical education. Schools with instruction in Armenian, Georgian, and Azerbaijan languages were opened in the Caucasus. The turning point in the development of the Russian educational system was the reform of the 1860s carried out as part of cardinal transformations under Czar/King Alexander II (1818--1881). The Statute on Elementary Public Schools of 1864 declared elementary education open to all social ranks. The reform strongly encouraged private and local initiative in establishing new schools. 5

In 1918–1921, the Democratic Republic of Georgia implemented crucial reforms in the field of education. The Law on Public Education was adopted. The education system was based on the principles of democracy, equality, universality, human rights. Schools taught the following subjects: Georgian language and speech, Russian and world literature, second foreign language (French, German, or English), history, political economy, law, psychology, logic, natural sciences and mathematics, hygiene, physical education, chanting and music, handicrafts and fancywork/needlework. Latin was an elective/optional subject. Alongside with the world history and non-Georgian language, teaching Georgian language and Georgian history was compulsory in all non-Georgian schools. At this time there were some privately operated schools. Their compliance with the country’s legislation and students and teachers’ rights were all monitored by the government. A significant number of schools were based in Tbilisi (Georgia). There were some private schools in Kutaisi as well. Their programs, plans and textbooks were reviewed by Ministry of Education. The annexation of Georgia by Russia in 1921 was followed by the changes in the school system as well. In April 1921, by the decision of the Revcom of Georgia, the People’s Commissariat for Education was established. The first task of the Leninist Cultural Revolution was to eliminate/eradicate illiteracy and transform public education on a social basis. In 1921, a commission set up by the Department of People’s Commissariat for Education of the Georgian SSR drafted the Republic’s “Uniform Labor School Regulations.” It was to provide free, universal polytechnic education for both sexes in Georgia to expand the network of pre-school institutions that were the basic principles of the new Soviet public education system. The education system of the Soviet Union was a classical model of education that was introduced from Germany and Israel.

Elementary schools were called the “beginning/beginner” level (in Russian: начальное, nachalnoye ), 4 and later 3 classes. Secondary schools were 7 and later 8 classes (required complete elementary school) and called “incomplete secondary education” (in Russian: неполное среднее образование, nepolnoye sredneye obrazavaniye ). This level used to be compulsory for all children (since 1958–1963) and optional for under-educated adults (who could study in so-called “evening schools”). Since 1981, the “complete secondary education” level (10 or, in some republics, 11 years) was compulsory. 10 classes (11 classes in the Baltic States) of an ordinary school was called “secondary education” (in Russian: среднее образование, srednye obrazovanye —literally, “middle education”). PTUs, tekhnikums, and some military facilities formed a system of so-called “secondary specialized education” (in Russian: среднее специальное, sredneye spetsialnoye ). PTU’s were vocational schools and trained students in a wide variety of skills ranging from mechanic to hairdresser. Completion of a PTU after primary school did not provide a full secondary diploma or a route to such a diploma ( Grant, 1979 ).

Such was the education system in Georgia when the country declared its independence on April 9, 1991, which then gained international recognition in 1992.

The rise of private schools in Georgia has been growing for more than 20 years since its independence from the Soviet Union (see the map of modern Georgia in addition 1). Throughout this period, it has undergone several stages of development. The first Georgian private school was established in 1991. Since then, its number has been growing over the decades. The most dramatic jump was in 2005 and 2006. The reasons behind the drastic increase are many, though the most significant changes can be linked to economic growth and educational policy. Almost at this time, a new model of educational system management was introduced. The government chose to finance students but not educational institutions. An education voucher enables a parent to choose to spend the received fund either on private or public schooling. As a consequence, private schools receive up to 20 million GEL from the state budget. The education policy has increased not only the number of private schools but the number of students as well.

In the beginning of the 2021/2022 academic year, there were 2,313 general education institutions in Georgia, including 2,086 public, and 227 private schools ( National Statistics Office of Georgia, 2019 ). 6 Prior to the reform, the public education system in Georgia was not responsible toward the government. The system was overloaded with bureaucratic functionaries that had dozens of overlapping obligations and duties, characterized by the lack of effective coordination, administration, and financial management mechanisms.

The introduction of a voucher system in the field of school education, has transformed the system, which was under state control. The market economic principle came into play and developed a supply and demand marketing mechanism for education. The introduction of the voucher funding in the school education served to improve school education and environment for a parental choice. School funding has also been a source for private schools. Despite the state voucher funding, the primary input is the fee paid by the parents. The data shows that fee is higher in cities, and it is significantly higher in Tbilisi, the capital of Georgia.

Rarely schools have sponsors or partner organizations that fund them. In most cases, this involves initial infrastructure development and school running costs (utility costs and hand-over costs). The patterns of manufacturing and education partnerships which are common in the western countries are rarely found in Georgia.

However, along with the advantages, this process has its adverse sides. The increased public funding has expanded the state dependence, letting the state interfere in the operation of private schools, invoking more standardization of the curriculum—the new systems of issuing school certificates through a unified national exam, the so-called branding proposed system. The latter encourages private schools to modify their success criteria (in some cases to worsen it) exchange for certain benefits from the state.

Currently, the primary indicator of private schools’ weakness can be their dependence on the state and the lack of instruments necessary for internal financial sustainability.

The researches show that the private schools are far more successful considering academic performance compared with the public ones. Figures 1 , 2 shows the quality level difference between various types of schools (including private schools). The table demonstrates the private schools advantage over other public ones. 7 TIMSS International Research of Study, 2015-2016.

Figure 1. Students’ grade in mathematics by type of schools.

Figure 2. Students’ grade in natural sciences by type of schools.

In private schools, higher academic performance level is the merit of not only quality learning, but various other reasons as well. Some private schools have their own policy and criteria of accepting the students, such as: testing and interview. Considering this factor, it may sound unfair to judge the schools according to their academic performance. The academic results depend not only on schooling surroundings, but on the conditions and support from the family either. Thus, because of this, it’s rather interesting point how the parent prioritizes the educational institution’s academic performance level during school choice process and final decision-making.

Research context and methodology

Goals and objectives of the research.

The research aims to describe the school choice process, it focuses on unveiling the factors and their interrelation while the parent choosing between two types of schools—private and public. First of all, the research aims to describe the parent’s perception of achieving success at school, what is the base for such belief, what the sentence—“School—base of future success” actually mean. How important is so called social index? The significance of the reputation and prestige of the educational institution during school choice process—as a guarantee for future success.

The key questions for the research were as follows: (1) How interested the parents are to be actively involved in school choice process and spend certain period of time for that? (2) What factors are considered by the parents during school choice and what is the source they receive information from? (3) Does the family’s socioeconomic condition and the kids gender have influence on the process?

Considering the research objectives, so called structural questionnaire composing of 68 questions was prepared.

During composing the questionnaire, various factors were considered including: international experience, advice from field experts, 8 comments and the research results 9 conducted in Georgia.

Considering the reviewed literature, several acknowledgments were worked out:

• The parents have access to the information mainly through their social environment, as a result of this the parents of the private school students are far more informed regarding various aspects of school, compared with the parents of the public school students;

• The parents of the private school students are more motivated about the information gathering and are also more involved in the school choice process;

• In case of highly educated and well-off parent, the probability that he/she will send the kid to the private school is of course high, as private schooling is associated with better education;

• Selection criterion is much sophisticated and in frequent cases the social factor appears to be more important than academic performance of the school. This happens because neither private nor public school is capable of fully satisfying the parent’s demands.

Research methodology

The present study is a quantitative study of face-to-face interviews, conducted with a fully structured instrument. The average duration of an interview was 1 h. A pre-stratified three-stage cluster sampling was used for the study. 25 public, and 25 private schools were selected, and 12 students were randomly chosen (one student per class) from each selected school. Totally, 300 students were selected from each types of schools. The interviews were conducted with the parent/guardian of the selected student. The student in the selected class was chosen from the school journal through simple random sampling. If the parents of selected student were absent or refused to be interviewed, the parent of next student on the list was chosen. It should be mentioned that there was no significant difference in non-response rate between private and public schools. Such a sampling design for each student in Tbilisi guaranteed equal probabilities of being chosen. The field study was conducted in May and June 2017 (see details in Addition 2).

Research limits

The main limits of the research were limited resources and time, thus only Tbilisi schools appeared to be beneficiaries.

Thus we can’t talk about those parents’ choices, living in other cities. Though it’s also noteworthy that 50% of private schools located in Tbilisi balance this problem. Another error was that we didn’t have chance to use qualitative methodology while analyzing the quantitative research results (including more detailed interviews and/or focus groups). 10 Hopefully these errors will be balanced through future researches.

Research main findings

The principle of choice.

As the received data showed, the parents who decided to send the kid to the private school appeared to be far more informed regarding various aspects of schooling, compared with the parents of the public school students.

Comparing the average index of two groups of parents (private and public schools’ students’ parents) regarding the quality information gathering before sending kids to school is much significant: private—78.5%, public—63.9% ( Table 1 ).

Table 1. Do you have information about the school details before making decision?

Besides the fact that private and public school students’ parents have different level of information regarding the educational institutions, there are other contradictions between them:

Access to information—the research showed significant difference between the private and public schools student’s parents’. The private schools’ students’ parents are more interested to receive valuable information happening in educational sphere through various channels including television (on a daily bases private-28,3, public-24.0), radio (on a daily bases private-3,8, public-3.1), internet (on a daily bases private-43,5, public-34.6) ( Table 2 ).

Table 2. How often do you read about education sphere updates via internet?

The quality of demand on the services offered by the school also differs: the private school consumers are far more demanding toward their school (that can be proved multiple times throughout the research) and demand on information is high too. That’s normal, as the private school student’s parents pay certain amount of money and their attitude is much demanding toward the service they receive, including the information sharing. Thus, the private school students’ parents are more informed compared with the public school students’ parents.

Social and Cultural Capital. According to the data, those who decided to send kids to private schools were influenced by their own social circle/friends, as 60% of the people they communicated with had their kids in private schools, the same was with the public schools—those who decided to send their kids to public school were influenced by their own social circle/friends as 92.5% of the people they communicated with had kids in public schools ( Table 3 ).

Table 3. Where do your friends’ kids study (mainly)?

Thus we can talk about (1) the sharp segmentation of the society, where the people are divided having their own social circle, and attitude toward private/public/state education system. (2) Education is very relevant for both groups of people and a serious issue of everyday discussion (private 20,8 and public 20,5—talks about education issues with their friends/relatives on a daily basis).

One more indicator showed such strict segmentation

On the following question: during the school choice process, did you make choice between public schools, private schools or both? The parents gave following answers:

63.5% of the private schools’ student’s parents were choosing only between private schools; 72.3% of the public schools’ student’s parents were choosing only between public schools ( Table 4 ).

Table 4. School selection criteria; 600 respondents, SE 4%.

The parents’ education and income connection with school choice

The demographic questionnaire vividly showed serious difference between the private and public schools’ parents’ income. This can be seen by the following data ( Table 5 ):

Table 5. How would you rank your family’s social level?

It also appeared that private schools’ students’ parents have better education ( Table 6 ).

Table 6. Parents’ education.

Both data show that the school choice is much linked to the parent’s education and income.

When the private schools’ students’ parents have higher education and good income (compared with the public schools’ students’ parents), the chance of sending their kids to private schools in future is inevitably high.

The gender of a child and a parent’s choice

Below in Table 7 is an official data set issued by the Ministry of Education—the number of students in private and public secondary schools by gender (October 2017).

Table 7. Distribution of pupils in private and public schools.

The data showed that both in private and in public schools, boys outnumber girls. In a private school, this difference is even more noticeable. If the proportion of girls among public school students is 4.1% lower than the boys, this difference is 10.3% in private school.

That allows us to assume that while choosing a school (whether private or public), along with other factors, the child’s gender plays an important role. In other words, boys are slightly more likely to be taken to private schools than girls.

The research showed significant difference between the private and public schools’ students’ parents regarding the access to information. The parents of the private schools’ students have better access to information and media channels as well as they are more interested to be better informed. Here are listed the factors defining school choice:

• Different level of demand toward the schooling services;

• The parents’ social environment;

• The parents’ education;

• The parents’ income;

• Kid’s gender.

Selection criterion

According to the results, there is a low competition between the private and public schools.

There is a competitive environment between the private and public school sectors. A public school cannot compete with a private school. The low competitiveness of public schools is reflected in parents’ assessments of various factors.

During our study, 38 factors were identified that affected the parents’ decisions. The date was analyzed using multifactor dispersion analysis. The factors later were grouped into 10 factors according to the statistical significant (0.5 and more). The results are given in Table 8 .

Table 8. School selection/choice criteria in Georgia? 600 respondents, SE 4%.

The table shows that higher the evaluation is, the parents’ attitude and assessment of the similar factor is high too. Higher than 0.1 evaluation factor is much significant for the school review that for sure influences the parent’s school choice process. The figures listed above make clear how the average factor assessment indicator differs in case of private and public schools (high and low). For instance: #1 factor—comfort, material-technical base—private schools have higher than average evaluation, 0.56 points (on 10-point rating scale) to this direction, though the similar factor evaluation for the public schools totals 0.51 points (on 10-point rating scale).

Thus, in case of private schools, the highest evaluation is defined by school’s material-technical base—0.56 points. Next important indicator is relationship between students and teachers—0.24 points; as well as preparing homework at school/extra study—0.22 points; no need of additional tuition—0.12 points and parental engagement, orientation on parents—0.12 points. In case of public schools, the table above shows that the evaluation of the majority indicators is lower than average.

It’s also interesting to compare the abovementioned answers to the fact, why did they send their kids to that particular school? ( Table 9 ).

Table 9. Why did you choose the school named by you?

The data above shows that, in reality, during school choice process, the key factor for the private schools’ students’ parents appeared to be following: good educational conditions—57.0%; high quality education—49.2%; safe environment—29.2%, comfortable for parents, offering extra services including transportation, extra study—28.3%. As for the public schools’ students’ parents, during school choice process, the key factors were as follows: affordability—50.7%; closeness to living area—31.7%; good educational conditions—31.0%; high quality education—23.3%.

A private school choice is mainly determined by a “family (high) financial status” factor and accounts for 24% of choice in favor of a private school.

Discussion of results

As it was mentioned above, during school choice process, the key factor for the private schools’ students’ parents were as follows: good educational conditions; high quality education; safe environment and parents comfort (extra services including transportation, extra study etc.). As for the public schools’ students’ parents, during school choice process, the key factors were as follows: affordability; closeness to living area and good educational conditions. As we see, these results totally coincide with the world examples and theories discussed in literature review.

Now it’s interesting to compare the parents’ expectations and real results assessment.

Our results demonstrate that primarily, a private school parent pays for the safety and emotional wellbeing of a child, and a quality education takes only a third place. About half of the parents of private school students believe that their children get a high-quality education, which allows us to assume that the other half of parents are not entirely sure whether the chosen school, which they pay money to, gives a child an excellent quality education. The answer “school gives everything for a successful future” comes in fourth, and half of the private school parents think so ( Tables 10 , 11 ).

Table 10. Why are private schools better than public schools?

Table 11. Why are public schools better than private schools?

According to the answers given by public school parents, there are far worse outcomes: The 2/3 of the parents of public-school students are not convinced that the school provides quality education, and 4/5 of parents do not believe that the school provides everything for a successful future.

Private school children’s parents are convinced that: a school can provide a safe environment—86.8%; their child feels good at school—82.0%; the school provides quality education—58.8%; the school gives everything for a successful future—53.6%. In the case of public schools, the sequence is as follows: A parent feels sure that: a child feels good at the school they choose—61.1%; the school can provide a safe environment—52.6%; the school provides quality education—31.8%; the school gives everything for a successful future—22.7%.

Despite such conflicting assessments, about half of both public and private school parents (43.4% of private school parents and 57% of public-school parents) believe that it is impossible to obtain a quality education without the help of tutors and family.

These results just partly coincide with the forth probability we made, to be more precise, overall neither private nor public schools totally satisfy the parents’ demands. Thus, here we come to Blake and Mestry (2021) opinion, discussed in literature review above, regarding the parents’ utopic expectations. If we consider the fact that the parents receive information mainly from their relatives or friends, it will be much interesting if the interviewed parents’ experience can have influence over the decision criterion and structure, of their relatives and friends in future. Thus, this can become the issue of additional research.

Both private and public-school parents try to compensate for the school’s shortcomings by arranging tutoring and home studying. The results of the study demonstrate that public school students are more likely to study with tutors than private school students. When it comes to the arts, sports, other extracurricular activities, more private school students are engaged in the activities than public school students.

The question is why parents pay (quite a lot) money to a private school if they are not sure about high-quality education. It is possible to conclude that this sequence of factors reflects the priority of the private school student’s parent—firstly safety, later emotional satisfaction, and only then quality education and the necessary conditions for future success and here we can compare and see similarity of our study results with Kisida and Wolf (2015) .

Theoretically, it is possible that, among the various factors (described in detail in the central part of research results), presented to the respondents, we missed to include the criteria which would explain why parents still send their children to public schools even when there is nothing that prevents them?

In order to address this suspicion, the survey included two open questions, to which the respondents replied unlimitedly—1. Why are private schools better than public schools? 2. Why are public schools better than private schools? The answers were as follows:

It can be assumed that for most parents of public schools due to economic conditions, they cannot provide their children with private school education, and the choice of public school is a forced decision. To this end, the educational situation in Georgia somehow coincides with the Bosetti (2007) study explaining that—having alternatives and right to make choice is rather important.

Having considered the above, we can conclude that private and public-school parents have different attitudes toward school education, as well as parental beliefs about their child’s future success in school education. This totally coincides with the conclusions and examples by Hatcher (1998) .

We can only assume that, since the data do not allow interpretation—it may be due to the different socioeconomic state of the families of private and public-school students (according to the survey). Income gives more choice to high-income families than low-income families—this is what the given findings/results reflect.

One of the limits of our study/research is that we don’t have enough material/evidence for finally strengthening this conclusion and that can become the issue of further/future research as well. Though the results discussed in previous paragraphs enables us to say that the school choice process is much linked with the parents’ education and income, and these results coincide with our third probability and with Robershaw et al. (2022) conclusions as well.

One more issue studied by us was a wish to change the school. The study asked: “Do you think you would take your child to another school if there were not any financial or other problems?” By this question, parents are hypothetically given a choice that they may not have. 89.6% of the parents of private school students would choose the same school, which is understandable. All survey data show that the parents of private school students are more-or-less satisfied with their school choices. In case of public school students’ parents’, the majority of them would like to move their kids to private schools (33%). To this end, our results coincide with Bosetti (2004) research results. Though we should also underline the parents who don’t support the idea to move their kids to other schools and they name 2 arguments for that:

• They think that “more or less all schools are the same,” thus school changing is pointless;

• In public schools the students gain serious social experience as they communicate with various types of people that can be a base for successful future.

As we see both arguments coincide with the ones named by the school choice theory opponents we discussed during literature review.

Concerning the information gathering, the study showed that during the school choice process, the private schools’ students’ parents are far more informed regarding various aspects of school, compared with the parents of the public school students. Thus, all these is conditioned by several requirements:

• In private sector there is a bigger choice and the parents are interested to gather as much information as possible to select the most appropriate and affordable variant for them. Thus, the parents of the private school students are more motivated about the information gathering and are also more involved in the school choice process than public school students’ parents;

• Because of superior social-cultural capital, the private school student’s parents have better access to useful information;

• The private school student’s parents pay certain amount of money and their attitude is much demanding toward the service they receive, including the information sharing. Thus this is the reason why the private school students’ parents are more informed compared with public school students’ parents.

All in all, our results have clearly shown that there is a difference between private and public school students’ parents. 75% of private school parents and 25% of public-school parents stated that they started thinking about to which school they would take the child when a child was 1-year-old. When parents started thinking about the school preference, the average age of a child was 1–2 for private school parents, and 3–4 for public school parents.

All these totally meet our expectations (see the probability 1 and 2) and the cases discussed in the literature review (see Smrekar and Goldring, 1999 ; Bosetti and Pyryt, 2007 ; Davies and Aurini, 2011 ).

Comparison of private and public-school students’ outcomes is a heavily debated topic among many researchers. Most of them show the unquestionable success of private schools compared to public schools. The study conducted by Coleman et al. (1982) also shows this advantage even when the socioeconomic status of the student is considered. The same results can be found in our study. The research results make it clear that the school choice much depends on the parents’ education and income. These results totally coincide with our third probability theory.

Furthermore, children’s gender also plays an essential role in school choice. The number of boys in both private and public schools exceeds the number of girls. In a private school, this difference is even more noticeable. In this respect our survey is echoing the findings of Bellani and Ortiz-Gersavi (2022) .

One of the issues, that appeared in your research and was not the part of other international researches, was the number of kids in family and its influence on school choice process. Our study demonstrated a link between the number of children in the families (families with children under 18) and the parents’ choice—the more children in the family are, the more likely they are to go to public school. On average, families whose children attend a public school have more members. The families of public-school students consist of 4.58 members on average, and the families of private school students consist of 4.44 members on average. There are also, on average higher numbers of school-aged children—the ratio of children under 18 is 4.58 on average, and on average, 4.44 for private-school families. Thus, for sure this factor defines the family’s financial condition, and this coincides with the third our probability and abovementioned theories.

As we saw, the private school students’ parents’ are more likely engaged in schooling process. Private school parents are also encouraged by the schools themselves. As Chubb and Moe (1990) state, for private schools, a parent and a student are extremely central figures compared to public schools. Schools are more active in communicating with parents, as their successful communication is significantly related to their awareness, so a parent who is motivated to choose between the private schools is also helping private schools with their information policies. According to same authors a state school is a product of the state policy. State schools are controlled by a hierarchical system of state administration and democratic control. The policies adopted for the public schools are the result of the conflicting and reconciling interests of the various hierarchical branches of administration. Consequently, state schools offer a similar product to parents. Consequently, the need to obtain information about a particular public school in comparison to a private school is much less. Public school student’s parents try to fill the school gaps with private tuition and with the education the kids can receive from the family itself. This shows one more time that generally, the parents are much interested to provide perfect future for their kids, though socioeconomic conditions, environment, poor educational system limits their choice.

Once our results compared to the existing literature and theory, one can see that our study conducted in Georgia follows the trends of the developed countries, known as the “Heyneman-Loxley effect.”

As it was mentioned above for several times, the aim of the research was to study and describe the school choice process. The research focused on unveiling factors and their correlation during private and public schools’ choice process by the parents. Key issues of the research were as follows: (1) How interested the parents are to be actively involved in school choice process and spend certain period of time for that? (2) What factors are considered by the parents during school choice and what is the source they receive information from? (3) Does the family’s socioeconomic condition and the kids gender have influence on the process?

The study/research results are summed up in the following conclusion:

• The sharp segmentation of the society, where the people are divided having their own social circle, and attitude toward private/public/state education system;

• Education is very relevant for both groups of people and a serious issue of everyday discussion (talks about education issues with their friends/relatives on a daily basis). During the school choice process, the parents of the private school students are far more informed regarding various aspects of school, compared with the parents of the public school students; The parents of the private school students are more motivated about the information gathering;

• There are listed several factors defining the specific school choice:

∘ Different demands toward the service provided by the schools

∘ Parents’ socioeconomic condition

∘ Parents’ education

∘ Parents’ income

∘ Kids’ gender

∘ Number of kids in the family

• During the school choice process, the key factor for the private schools’ students’ parents were as follows: good educational conditions; high quality education; safe environment and parents comfort (extra services including transportation, extra study etc.). As for the public schools’ students’ parents, during school choice process, the key factors were as follows: affordability; closeness to living area and good educational conditions. As we see, these results totally coincide with the world examples and theories discussed in literature review;

• It can be assumed that for most parents of public schools due to economic conditions, they cannot provide their children with private school education, and the choice of public school is a forced decision;

• The private school students’ parents are more confident in their choice (that they chose the right school for their kids) than the public school students’ parents;

• Our results demonstrate that primarily, a private school parent pays for the safety and emotional wellbeing of a child. In the case of public schools’ parents feel sure that: a child feels good at the school they choose and the school can provide a safe environment. The data show that the following answer—“provides quality education” is much important for both public and private schools’ students’ parents and in the list of trust is ranked on the third place;

• The parents of the private schools’ students’ are more confident and think that there is enough choice of schools in Georgia than the parents of the public schools’ kids’. But about half of both public and private schools’ students’ parents believe that it is impossible to obtain a quality education without the help of private tuition and family.

It’s worth mentioning that, generally the research results fully coincide with the school choice theory arguments and the research findings conducted in the similar field. All these are described and presented in the first part of the article. The probabilities listed on the base of the current data, that the information source, the parent’s information level, the parents’ engagement as well as the family’s socioeconomic and demographic status play integral role in the school choice process appeared to be genuine. Apparently, the parents are much interested to provide perfect future for their kids, though socioeconomic conditions, environment, poor educational system limits their choice.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (Ethics Committee) of Ilia State University Tbilisi, Georgia, protocol code ECISU 0l0gl20r7. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

Author contributions

AT carried survey. AT, LT, and WS analyzed the survey results. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

• ^ John Stuart Mill, 1859, On Liberty.
• ^ According to author educational pluralism charts a middle course, between libertarian approach and status quo , that offers an expansion of educational options within a common accountability framework.
• ^ The Education Reform Act 1988 (and subsequent case law) gave all families the right to express a preference for any school (even one outside their Local Education Authority) and denied schools the right to refuse anyone entry until a planned admission number was reached.
• ^ CHAT is a cross-disciplinary framework for studying how humans purposefully transform natural and social reality, including themselves, as an ongoing culturally and historically situated, materially and socially mediated process ( Roth et al., 2012 ).
• ^ Russian Federation - History Background - Education, Schools, Educational, and School - StateUniversity.com https://education.stateuniversity.com/pages/1265/Russian-Federation-HISTORY-BACKGROUND. html#ixzz6swsAsSYb .
• ^ https://www.geostat.ge/en
• ^ National Assessment and Examinations Center official website https://timssandpirls.bc.edu/timss2015/international-results/wp-conten t/uploads/filebase/full%20pdfs/T15-International-Results-in-Mathematics.pdf .
• ^ 10 detailed interviews were conducted with the field experts beforehand. During the interviews current situation in Georgia was discussed, as well as problems and issues for research. Later the draft of used questionnaire was also discussed with them.
• ^ We studied following researches: Caucasian Barometer 2010–2016 ( www.caucasusbarometer.org ); The General Education Voucher Funding Effectivity Research in the Context of Equality, 2014 ; The research was conducted by Centre for Civil Integration and Inter-Ethnic Relations (CCIIR) in the frames of the East West Management Institute (EWMI) Policy, Advocacy, and Civil Society Development in Georgia project (G-PAC), funded by USAID. The costs spent on general education and its results, 2013–2016; Private Schools Research in Georgia, 2018 ; Besides this 70 private school teachers and 70 public school teachers were interviewed.
• ^ For instance: Parents motivation when they have different approach while making school choice in case of sons and daughters; Private school choice motivation, when they still have to pay money for extra tuition etc.

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Keywords : education, school choice, public school, private schools, quantitative research, education research, Georgia

Citation: Tarkhnishvili A, Tarkhnishvili L and Strielkowski W (2022) Factors influencing the choice of private or public schools: Evidence from Georgia. Front. Educ. 7:910593. doi: 10.3389/feduc.2022.910593

Received: 01 April 2022; Accepted: 31 October 2022; Published: 13 December 2022.

Reviewed by:

Copyright © 2022 Tarkhnishvili, Tarkhnishvili and Strielkowski. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Anna Tarkhnishvili, [email protected] ; Levan Tarkhnishvili, [email protected]

This article is part of the Research Topic

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The strategies of private higher educational institutions during the Covid-19 pandemic. A review of literature

Mauricio maynard do lago.

a COPPE Production Engineering Program, UFRJ Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

c Cefet-RJ – Centro Federal de Educação Tecnológica Celso Suckow da Fonseca, Rio de Janeiro, Brazil

Elton Fernandes

b COPPE Transportation Engineering Program, UFRJ Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Raphael Cunha Barboza

This paper sought a qualitative/quantitative bibliometric approach, using the literature review, to present the main strategies with a bias toward sustainability, used by private Higher Education Institutions, in an attempt to neutralize the effects of the lockdown caused by the Covid-19 pandemic. To meet the reliability requirements of the source of the papers used, a search was made in the Web of Science and Scopus databases, where 47 papers were selected. As a result, there was a scattering of strategic actions in several works. However, no actions were identified that orientated to deliberate planning, as a way of confrontation with the new environment that was quickly established, caused by the Covid-19 pandemic. Instead, we found fragmented or emerging strategic actions, mostly concentrated on Teaching activities as a possible response, given the circumstances, to a situation that presented itself as an emergency. This study divides the actions identified in the strategic areas of the Institutions into Teaching, Research, Extension, Business Management, and Teacher Training.

1. Introdution

Periods of crisis generate impacts on the performance of organizations, establishing new relationships between market participants in which they operate. ( Salunkhe, Rajan & Kumar, 2021 ; Wade, 2009 ). The Covid-19 disease spread rapidly across the planet, forcing the closure of Higher Education Institutions (HEIs) around the world, reaching all countries in a way never seen before ( Akinbi, Forshaw, & Blinkhorn, 2021 ; Cordova et al., 2021 ; Tomé & Gromova, 2021 ). The crisis forced the governments of countries around the world to decree the suspension of school activities associated with measures to safeguard the financial health of HEIs, in an attempt to slow down the spread of Covid-19 ( Pan, 2021 ; Barnová, Krásna, & Gabrhelova, 2020 ). As a result of this crisis, HEIs were forced to migrate to remote mode, forcing professors, students, and the administrative staff of HEIs to quickly adapt to the new reality ( Bartolic et al., 2021 ; Biwer et al., 2021 ). This sudden migration revealed social inequalities, which became challenges to overcome in the attempt to offer distance education for all ( Oyedotun, 2020 ).

HEIs with experience in remote activities found this migration easier. This does not exclude the need for interaction provided by face-to-face activities ( Kocak-Tufan, 2020 ; Appoloni et al., 2021 ). Thanks to advances in communication technologies and the need for survival, HEIs have had accelerated access to remote learning platforms (McInnes, Aitchison, & Sloot, 2020). According to Rababah et al. (2021) , the postponement of projects in HEIs was inevitable, in addition to the need to review their priorities. As a consequence, budgets had to undergo revisions, affecting all stakeholders ( Behan, 2021 ). The term sustainability commonly refers to environmental issues, although the term can be extended to the long-term intra-organizational environment ( Neubert & Bruno, 2016 ).

Based on the research carried out, this is the first study to assess the effects of Covid-19 from the perspective of Teaching, Research, Extension, Teacher Training and Business Management. This study differs from the others, as the researched articles deal with these areas of Teaching, Research, and Extension in education, in isolation. The present work elaborates its evaluations under the perspective of the Teaching, Research, and Extension areas together, associating them also under the perspective of Teacher Training and Business Management. This view becomes important, as it provides a broad understanding of the enterprise, thus facilitating decision-making. In addition, there is a need to review the literature on initiatives developed by private HEIs, whose sustainability is more vulnerable to the challenges posed by the pandemic. This review aims to provide relevant information to identify sustainable strategies developed by these institutions and to verify gaps in the literature. Thus, this review focused on previously published studies that addressed private HEIs that, during the Covid-19 pandemic, sought to develop sustainable strategies from the entrepreneurship point of view. The research questions that this review proposes are: Have private HEIs been able to develop sustainable strategies from the point of view of business management during the Covid-19 pandemic? What were the strategies that best responded to the challenges posed by the Covid-19 pandemic? This study uses a bibliometric and qualitative approach in the literature review process.

2. Methodology

The study uses an approach bibliometric qualitative/quantitative through the literature review process to define a set more focused on the central theme. Gil (2008) states that bibliographic research is developed based on material already prepared, such as books and papers. Having an exploratory character, it proposes an analysis of the different positions on a problem. Cervo, Bervian & Da Silva (2007) argue that in bibliographic research, the source and information are presented in the form of documents, whether printed or electronic, and Marconi & Lakatos (2010) explained that the goal is to place the researcher in contact with everything that has already been produced on a given topic. Following these guidelines, the sources of information, the search algorithms and the steps for defining the set of documents to be analyzed qualitatively were defined.

The research material (scientific articles) was searched in the Web of Science and Scopus databases. Only complete articles were included, excluding abstracts and other types of publications accepted. Articles that contained only published abstracts were excluded.

2.1. Procedures used in the research

The delimitation of the scope and definition of the study parameters, led to the definition of the keywords used in the research of the databases, which were: “strategic”, “university”, “sustainable”, “sustainable management” and “Covid-19”. The use of keywords in English was used in order to cover the largest number of publications, the search feature used the Boolean operators AND and OR to form the search strings. Papers from the last 3 (three) years were selected due to the Covid-19 epidemic event being the generating factor of the events that guide the research. Using the combination University AND Strategic AND Sustainable AND Covid-19, 64 occurrences were found; using the combination University AND Strategic AND (Sustainable OR Covid-19) 1122 occurrences were found; using the combination University AND Strategic AND (“sustainable management” OR Covid-19), 86 occurrences were found; using the combinations University AND Strategic* AND Covid-19, 74 occurrences were found; using the combinations University AND Strategic AND “Sustainable Management” AND Covid-19, 36 occurrences were found. In order to expand the ability to search for studies on the subject, the combination (school* AND financ* AND universit* AND privat* AND pandem*) was used, where 26 papers were found, totaling 1408 occurrences. After selection using the filters: topic selection (management, business, Business Finance, education educational research, Education Scientific Discipline), selection by full papers and selection by languages (English, Portuguese and Spanish), limited to the periods from 2020 to 2022,154 papers remained. After the selection based on the reading of the abstracts, where only the articles that addressed private Higher Education Institutions were chosen, 68 articles remained and after reading the articles, 47 studies were selected, that met the research objectives. This bibliographic review took place between March 15 and 31, 2022. Fig. 1 shows the flowchart of the selection of articles performed.

Flowchart of article selection.

Once the most relevant documents were defined, the classification and analysis of the strategies of private educational institutions were carried out.

3. Results and discussions

The network maps were created using the VOSviewer software, through the bibliographic data obtained from the analysis of the articles selected for this review. The network that represents the co-authorship relationship between authors shows the level of cooperation. In the elaboration process, 159 authors were identified divided into 43 clusters, with 6 (six) main clusters ( Table 1 ): Cluster 1, formed by 12 (twelve) authors who studied business management in universities, focused in the area of social responsibility during the pandemic; cluster 2, formed by 11 (eleven) authors who studied the teaching area, more precisely the impacts of covid-19 on returning to classes at universities; cluster 3, formed by 10 (ten) authors focused on extension activities with the involvement of the university community in order to develop ideas to increase safety and well-being in the campus; cluster 4, formed by 9 (nine) authors, who discussed the difficulties of maintaining internationalization activities in Latin America during the lockdown; cluster 5, formed by 7 (seven) authors who studied, within the context of Teaching, the importance of synchronous activities for students during the pandemic; and cluster 6, formed by 7 (seven) authors who studied the analysis of the practice of distance learning, where students value time with family and the availability of flexible hours more than academic experiences, resulting in proximity to cluster 3.

Main clusters.

Fig. 2 represents the main keywords used by the authors, where 4 (four) significant clusters were found. The term Covid-19 is at the heart of the issue, showing a direct relationship with almost all of the identified words, with some words keeping relationships with each other. The proximity between the words points to the research theme. The word Covid-19 (green cluster) and its ramifications (basic medical science, business schools, covid-19, school management) takes on a prominent role as it represents the environment that triggered the entire process of change throughout society; higher education (yellow cluster), and its connections (corporate social responsibility, digital skills, higher education, student-centred learning, sustainable development goals), standing out as the main object of the study. The red cluster is composed by the terms e-learning, education and economy with their connections (e-learning, economy, education, knowledge manager, management, student satisfaction index model, sustainability, teaching) sumarize the main action that involves the Business Management, which were used by the educational institutions as immediate resources for the continuity of activities, avoiding the flight of financial resources during the pandemic; and the blue cluster formed by the term distance learning and its derivations (education innovation, Microsoft teams, motivation for learning, teacher education), which represents the main strategic action used by HEI as an immediate response aiming at the continuity of their activities.

Co-occurrence between the authors' keywords.

Fig. 3 represents the incidence of terms in all the papers, with 316 terms found in the base of the texts with at least two occurrences. From this combination, 4 (four) clusters were generated, highlighting the cluster in red which covers themes related to the university and its internal issues such as controlling the movement of people and strategic approaches as a solution; the green cluster highlights teaching activities, emphasizing academic issues, business sustainability and its impacts on the student body; the blue cluster gathers the studies that evaluated the main strategic action used by the HEI, which was remote teaching; and finally the yellow cluster, where the papers discussed the impacts of Covid-19 on HEI from the point of view of the enterprise and its impacts on stakeholders.

Incidence of terms.

Table 2 shows the considerable experience in scientific production of the first authors of the selected papers. The productions found in the Web of Science and Scopus databases were counted, without excluding repeated documents. Authors with at least 3 (three) publications in the research area of this study were highlighted.

Production of the main authors.

Table 3 shows the countries in which there were the highest number of publications. Those who obtained at least 02 (two) publications on the subject were selected, showing a balance of publications between countries, but keeping the United States in the lead of scientific production in the area, although most of the studies are from Europe.

Countries of origin.

Table 4 presents the scientific magazines that published more than 1 paper on the topic addressed by this literature review. Among the 27 magazines selected by this study, Sustainability stands out, mainly covering studies on Sustainable Management and Strategies and Social Responsibility.

Publications by magazine.

Up to this point, the vast experience of the main selected authors has been demonstrated. The distribution of surveys selected by countries is balanced. In addition to presenting the scientific journals that concentrated the largest number of publications in the researched area. From this point on, it is important to show the strategic areas that were the focus of the main interests.

This study selected 47 papers based on strategic areas of private HEI, such as Teaching, Research, Extension, Business Management and Teacher Training. Table 5 , built from the information contained in Table 6 (Annex 1), where contains the analysis of selected papers, presents the distribution of authors by strategic areas.

Approach by strategic areas.

Analysis of selected papers.

In the Teaching area, the articles addressed the relationship between teachers and students in the virtual environment, as well as the consequences of moving away from the academic environment, in addition to highlighting the lack of planning when migrating to remote activity ( Gourlay, 2021 ; Serna-Tuya et al., 2020 ; Sobral et al., 2021; Lee & Jung, 2021 ; López, 2022 ; Bautista, Bleza, Buhain, & Balibrea, 2021 ; Lara-Pietro et al., 2021 ). It was also highlighted in the papers, the concern with changes from face-to-face teaching to remote activity, the use of teaching technologies and their adaptations, as well as the hybrid teaching system, the concern with the health of teachers and students due to the need for confinement ( Aristovnik et al., 2020 ; Degollación Coz & y Rimac Ventura, 2022 ; Drozdikova- Zaripova et al., 2021 ; Mishall, Meguid, Khalil, Lee, & Lisa, 2022 ; Monteiro & Leite, 2021 ; Owolabi, 2020 ; Owolabi & Bekele, 2021 ; Perrin & Wang, 2021 ; Ribeiro & Corrêa, 2020 ; Yusof, Atan, Harun, Rosli, & Majid, 2021 ), in addition to the concern with maintaining the course's internationalization activities ( Cordova et al., 2021 ). In summary, in the area of education, institutions focused their concern on the continuity of academic activities, partly as a mission, and partly as a fundamental action for financial survival.

In the Research area, the study presented indicates that in most Institutions the flow of resources destined for the research area was interrupted, keeping only the resources for research in activities directly related to the Covid-19 pandemic, in addition to the concern with the aspects of ethics involved ( Malherbe & Schutte, 2021 ). The fact that I did not find more articles on the maintenance or attempt to maintain research activities during the pandemic, reveals that during a crisis and because of the need to reduce costs, the following conditions were observed: a) given the difficulty of carrying out laboratory activities remotely, many types of research were interrupted; b) that, given the need to reduce costs to ensure the survival of Educational Institutions, research activities were relegated to the background.

In the Extension area, a study was found that emphasizes partnership actions with companies to prepare students through practical activities to insert them into the job market, and another highlighting the effort to seek community participation in the decision-making process. of the Higher Education Institution ( Hodges & Martin, 2020 ; Day et al., 2021 ).

In the area of Business Management, the works found focused their actions on satisfying the interests of their Stakeholders, through the maintenance and reinforcement of values and strategic guidelines (Mission and Vision, Values and Objectives) as a value proposition ( Behan, 2021 ; Falkenstein, Hommel, Snelson-Powel, & Annie, 2022 ; Ungheri, Lelis, Soares, Ferreira, & Da Silva, 2021 ; Badawood, 2021 ; - Tawaha, 2021 ), agility in responses, the importance of accounting data and the approximation between administration and teachers and other employees and other types of actions, as a way to streamline strategic actions and reduce costs, prioritizing activities, without prejudice to the quality of the service ( Tomé and Gromova, 2021 ; Ihnatova et al., 2021 ; Ng, 2021 ; Makgahlela et al., 2021 ), for the importance of the strategy based on institutional Information and Communication Technology, using social media as a strategic communication tool ( Al-Youbi et al., 2020 ; H ashim et al., 2022), in addition to the impacts of the pandemic on social responsibility activities and actions ( Rababah et al., 2021 ).

In the area of Teacher Training, in general, training was limited to training for the exercise of remote activity, more specifically in an attempt to become familiar with the virtual environment ( Salgado-Guitiérrez et al., 2020 ; Valeeva & Kalimullin, 2021) .

Based on the analysis of Table 6 , Graph 1 can be drawn up, showing that most research focused their interests on Teaching activities (51%) due to the urgency of Institutions to return to activities, even remotely. The Research activity accounted for 2% of the studies, which may indicate that the Educational Institutions prioritized the continuity of activities in the classroom, instead research activities. On the one hand, due to the need to guarantee a cash flow to provide financial sustainability and, on the other hand, as a way to reduce costs, paralyzing, even if momentarily, investments in research. Papers that highlighted Extension activities accounted for 4% of publications as a result of efforts to keep these activities running, even remotely. The papers that showed Business Management accounted for 36% of published research, which deserves attention, since the lockdown directly put the enterprise at risk, forcing HEI to reinvent themselves with the aim of remaining sustainable without losing sight of the post-pandemic period. Teacher Training activities accounted for 4% of scientific production, a percentage that reinforces the interest of Teaching Institutions in continuing with school activities, however, with little concern to train teachers, understanding that the situation was momentary, and that soon, the activities would return to the “normal” model of teaching.

Strategic areas.

After evaluating the works selected by this review, listed in Table 6 and it was demonstrated that the Institutions' priority was to maintain the continuity of classroom activities remotely (Teaching) leaving the activities of research in the background as an attempt to maintain the financial sustainability of the enterprise, and Extension, since most activities involve direct contact with the community. As an attempt to maintain the sustainability of the enterprise, the activities involving Business Management focused their actions on responding to possible concerns of the stakeholders. The Teacher Training activities emphasized the importance of preparing the teaching staff as an attempt to maintain the quality of teaching in the remote environment. Based on the strategic guidelines of renowned researchers, the strategies identified in this review can be analyzed.

3.1. A comparative analysis based on the main authors on strategy

To guide managers of private Higher Education Institutions, we present a comparative analysis between the concepts of the main authors in business strategy and the behavior observed by most of the Higher Education Institutions surveyed.

Porter (1986) states that the essence of strategy is to develop unique differentials that lead the organization to a sustainable competitive advantage over rivals, but what was observed in this review is that the actions identified portray the need for survival as a preponderant factor. In the future, this experience should support the development by HEI of competitive strategies. However in face of the pandemic phenomenon, actions responded to an emergency situation where, according to the studies evaluated here, the absence of planning and a deliberate strategy that already had the effects of a disruptive event prevailed.

Johnson, Scholes, and Whittington (2005) , and Mintzberg, Ahlstrand, and Lampel (2000) , understand the concept of deliberate strategy as an intentional movement to influence a given situation and emerging strategies as a learning process of the organization about the situation faced, and its ability to deal with her. In this study, actions that resembled a deliberate strategic formulation model were not identified in the selected works, approaching more to an emerging model, in which the organization seeks to learn from the reality that is presented and the impositions defined by the environment of business.

Johnson et al. (2005) , define strategy as a long-term activity, related to the scope of the organization to obtain an advantage over competitors, adjusting its strategy to environmental forces. However, it can be understood as the creation of opportunities through the development of competencies combined with the creation of values, satisfying the expectations of its stakeholders. The researched articles demonstrated the importance of the stakeholders in the construction of the strategies chosen by the private HEIs, and with the concern in the development of short-term actions. No evidence was found of attempts at strategic elaborations seeking a competitive advantage, but actions to adapt to the new environment that presents itself intending to survive an unexpected situation.

The formulation of fragments of strategies that met an emerging need was evidenced, thus approaching the definition of Mintzberg et al. (2000) .

Private Higher Education Institutions faced a major challenge during the height of the Covid-19 pandemic. Unlike Federal and State Higher Education Institutions that, due to their characteristics, receive government resources to maintain their activities, private HEIs needed to develop creative and innovative strategies to remain economically viable, since the resources for their maintenance as an organization are derived from the of course tuition payment.

And based on the analysis of the selected papers, the results found point to the lack of deliberate strategies, and yes evidence was found that private HEIs, in an attempt to maintain the viability of the business, resorted to emergency actions as an attempt to survive. The content of the papers on the strategies defined here makes clear the option for the continuity of academic activities, through remote teaching, to the detriment of research activity, as a way to reduce the impacts of the Covid-19 pandemic on HEIs, ignoring the consequences of this choice in the quality of teaching.

4. Conclusion

The present work reviewed the available bibliography, to contribute to the managers of private Higher Education Institutions identifying whether these Institutions were able to develop sustainable strategies as a way of mitigating the effects of the Covid-19 pandemic crisis. Therefore, two research questions were elaborate: Have private HEIs been able to develop sustainable strategies from the point of view of business management during the Covid-19 pandemic? What were the strategies that best responded to the challenges presented by the Covid-19 pandemic? As a result, we can see, in a comparison with renowned authors on the subject, that emerging strategies prevailed over deliberate strategies. The research also points towards a strategic action that prevailed, through the studies presented, which was the direction of actions aimed at remote teaching, as the best possible response to the challenges that arise.

As research limitations, this study does not address the impacts of transferring to remote teaching on students' health and its consequences for the continuity of post-pandemic teaching, moreover, it leaves some gaps that need to be filled with future research, such as: a) Was remote emergency teaching able to maintain the same level of quality as face-to-face teaching? b) As part of a sustainable strategy, were the other jobs in the HEIs preserved? c) What is the impact of the return to face-to-face activities on the strategies of Higher Education Institutions?

Other studies must address this issue, as it is a strategic mistake to believe that there will be a return to normality in terms before the pandemic.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

We wish to acknowledge the National Institute for Humanities and Social Science (NIHSS) Through the BUT BRICS Research Institute Grant Ref: BR122/1215 for supporting this research.

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• Unintended Consequences of Regulating Private School Choice Programs: A Review of the Evidence

from the book Regulation and Economic Opportunity: Blueprints for Reform

Executive Summary

The number of private school choice options has continued to grow ever since 1990. Today, 65 private school choice programs are in operation in 29 states, the District of Columbia, and Puerto Rico. In this chapter, education policy experts Dr. Corey A. DeAngelis and Dr. Lindsey M. Burke review the evidence on the effects of school choice programs that give families wider options to move between schools. Overall, they conclude that school choice programs work well and, on balance, that increasing the regulatory burden carried by school choice programs sometimes results in lower participation rates and lower quality of private schooling. They conclude that:

• Regulators should approach private schooling programs with targeted rules to alleviate demonstrated failures that avoid unintended consequences.
• Policymakers considering reforms should avoid intrusive regulations that discourage specialization among private schools.
• Requiring randomized admissions or requiring that private schools administer standardized tests may explain cases where private voucher programs fail to meet or exceed the results that public schools create.

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The number of private school choice options has continued to grow ever since 1990, when the first modern-day school choice program in the United States was established in Milwaukee. Today, 65 private school choice programs are in operation in 29 states, the District of Columbia, and Puerto Rico. These include vouchers, tax credit scholarships, and education savings accounts. 1 EdChoice, The ABCs of School Choice: The Comprehensive Guide to Every Private School Choice Program in America , 2020 ed.   During the Trump administration, officials put a renewed spotlight on school choice using the bully pulpit to make the case for its efficacy, signing into law a reauthorization of the DC Opportunity Scholarship Program, and in its push for a federal tax credit scholarship program. Increased interest in, and availability of, private school choice programs raises questions about the extent to which these programs will generate a genuine variety of education options for families. Growth in school choice programs has also generated a debate about the extent to which these programs should be regulated, the form regulations should take, and whether regulations increase or impede the quantity and quality of education options available to families.

Private school choice programs enable families to move from public schools to private schools and to access other education products and services. Many families do so because they are looking for something not offered in the public-school sector, and believe that the private-education sector offers something different that will better suit the needs of their child. Government regulations, in the form of oversight provided through mechanisms such as state standardized testing, are appropriate for providing accountability in the public sector, since public schools are accountable to government officials and are less-directly accountable to parents. 2 Jason Bedrick, “Leave School Choice to the States,” TownHall.com , April 16, 2015.   But government regulations designed to hold the public system accountable are inappropriate for a system of private education, which is supposed to offer something different to families than the public system, and which is held to an arguably higher form of accountability: the market. 3 Bedrick, “Leave School Choice to the States.”   Families that are unhappy with any element of their child’s private school can vote with their feet and leave—an exit option that is more difficult for most families to execute in the residentially assigned public school system. Nevertheless, some scholars have made the moral case for government regulation of the private sector.

Former Hoover Institution research fellow Tibor Machan argued that there is a fundamental difference between government management and government regulation, contrasting national forests and parks and highways, which are government managed, with food and drug production, car sales, toy production, and so on, which are government regulated, but not managed. 4 Tibor R. Machan, “Government Regulation of Business: The Moral Arguments,” Foundation for Economic Education, July 1, 1988.   Private schooling falls into the latter category: private schools are privately managed and operated, but exist within a patchwork quilt of regulatory environments in the states. Moral cases for government regulation of the private sector have generally taken four forms: (1) Private corporations are chartered by the states in which they reside, and thus the government has a foothold to regulate the behavior of private entities. (2) Market failures—that is, instances when the market “fails to achieve maximum efficiency”—can produce waste. 5 Machan, “Government Regulation of Business.”   (3) Government regulations are needed to protect individual rights. And (4) there is sometimes judicial inefficiency—as seen, for example, in the adjudication of disputes involving pollution. 6 Machan, “Government Regulation of Business.”

Proponents of the regulation (sometimes referred to as accountability) of private school choice programs tend broadly to appeal to these moral arguments for government regulation of private entities. They argue that government “open admissions” regulations are necessary to ensure that private schools participating in school choice programs accept all students who apply, that the government should cap how much tuition a private school can charge so that it will not exceed the voucher amount and families on a scholarship can be guaranteed to afford it; that the government should require accreditation and standardized testing to ensure quality among participating schools. Moreover, proponents of private school choice regulations argue that such regulations are more likely to deter lower-performing schools from participating and therefore to increase the average quality of the private schools that participate. 7 Douglas Harris, “The Reform Debate, Part II: The Difference between Charter and Voucher Schools,” Education Week , November 11, 2015.

This chapter examines these arguments, with a particular emphasis on the Louisiana Scholarship Program—the most heavily regulated private school choice program in the country, and the only private school choice program that has produced negative academic outcomes for participants. We begin by looking at the experimental research on the impact of school choice broadly on academic achievement and attainment. Next, we review the literature on the impact of regulations on the quantity and quality of private schools in school choice programs. We conclude with a discussion of implications for federal and state policy.

Background to the Research Literature

We review the literature on the impact of regulations on private school choice programs. Our review strategy was twofold: First we gathered the universe of randomized controlled trial evaluations examining the impact of private school choice on student educational outcomes, including academic achievement and attainment. These randomized controlled trials include 16 studies on student academic achievement, published between 1998 (the first such evaluation ever conducted) and 2019 (the most recent evaluation published). Next we surveyed the correlational and descriptive literature on the impact of regulations on the supply of private schools and their quality, within the context of private school choice programs. We have included quantitative studies (seven studies), which use data to assess the types of schools that do or do not participate in voucher programs, and qualitative studies (eight studies), to understand the types of private schools that elect to participate in choice programs.

John Barnard et al., “Principal Stratification Approach to Broken Randomized Experiments: A Case Study of School Choice Vouchers in New York City,” Journal of the American Statistical Association 98, no. 462 (2003): 299–323; Joshua M. Cowen, “School Choice as a Latent Variable: Estimating the ‘Complier Average Causal Effect’ of Vouchers in Charlotte,” Policy Studies Journal 36, no. 2 (2008): 301–15; Jay P. Greene, Paul E. Peterson, and Jiangtao Du, “Effectiveness of School Choice: The Milwaukee Experiment,” Education and Urban Society 31, no. 2 (1999): 190–213; Jay P. Greene, “The Effect of School Choice: An Evaluation of the Charlotte Children’s Scholarship Fund Program,” Civic Report 12 (2000): 1–15; William G. Howell et al., “School Vouchers and Academic Performance: Results from Three Randomized Field Trials,” Journal of Policy Analysis and Management 21, no. 2 (2002): 191–217; Hui Jin, John Barnard, and Donald B. Rubin, “A Modified General Location Model for Noncompliance with Missing Data: Revisiting the New York City School Choice Scholarship Program Using Principal Stratification,” Journal of Educational and Behavioral Statistics 35, no. 2 (2010): 154–73; Cecilia Elena Rouse, “Private School Vouchers and Student Achievement: An Evaluation of the Milwaukee Parental Choice Program,” Quarterly Journal of Economics 113, no. 2 (1998): 553–602; Patrick J. Wolf et al., “School Vouchers and Student Outcomes: Experimental Evidence from Washington, DC,” Journal of Policy Analysis and Management 32, no. 2 (2013): 246–70.

Table 1. Effect of Private School Choice on Math and Reading Test Scores

*Statistically significant positive effects are detected for subgroups.

Note: RCT = randomized controlled trial. ”Positive” means that the study indicates a statistically significant test score benefit of private school choice overall. “Negative” means that the study finds a statistically significant negative effect of private school choice on test scores overall. “Null” indicates that the overall result reported for the outcome is not statistically significant. “Null to positive” means that statistically significant positive effects are detected for subgroups. Research on existing school voucher programs in Indiana and Ohio also found null to negative impacts on the academic achievement outcomes of participating students. These two studies, however, are not included because they are observational and cannot demonstrate that the negative outcomes were caused by voucher program participation.

Sources: Patrick J. Wolf et al., “School Vouchers and Student Outcomes: Experimental Evidence from Washington, DC,” Journal of Policy Analysis and Management 32, no. 2 (2013): 246–70; Joshua M. Cowen, “School Choice as a Latent Variable: Estimating the ‘Complier Average Causal Effect’ of Vouchers in Charlotte,” Policy Studies Journal 36, no. 2 (2008): 301–15; Jay P. Greene, “The Effect of School Choice: An Evaluation of the Charlotte Children’s Scholarship Fund Program,” Civic Report 12 (2000): 1–15; Jay P. Greene, Paul E. Peterson, and Jiangtao Du, “Effectiveness of School Choice: The Milwaukee Experiment,” Education and Urban Society 31, no. 2 (1999): 190–213; Cecilia Elena Rouse, “Private School Vouchers and Student Achievement: An Evaluation of the Milwaukee Parental Choice Program,” Quarterly Journal of Economics 113, no. 2 (1998): 553–602; William G. Howell et al., “School Vouchers and Academic Performance: Results from Three Randomized Field Trials,” Journal of Policy Analysis and Management 21, no. 2 (2002): 191–217; John Barnard et al., “Principal Stratification Approach to Broken Randomized Experiments: A Case Study of School Choice Vouchers in New York City,” Journal of the American Statistical Association 98, no. 462 (2003): 299–323; Hui Jin, John Barnard, and Donald B. Rubin, “A Modified General Location Model for Noncompliance with Missing Data: Revisiting the New York City School Choice Scholarship Program Using Principal Stratification,” Journal of Educational and Behavioral Statistics 35, no. 2 (2010): 154–73; Alan B. Krueger and Pei Zhu, “Another Look at the New York City School Voucher Experiment,” American Behavioral Scientist 47, no. 5 (2004): 658–98; Marianne Bitler et al., “Distributional Analysis in   Educational Evaluation: A Case Study from the New York City Voucher Program,” Journal of Research on Educational Effectiveness 8, no. 3 (2015): 419–50; Eric Bettinger and Robert Slonim, “Using Experimental Economics to Measure the Effects of a Natural Educational Experiment on Altruism,” Journal of Public Economics 90, no. 8–9 (2006): 1625–48; Ann Webber et al., Evaluation of the DC Opportunity Scholarship Program: Impacts Three Years after Students Applied , NCEE 2019-4006 (National Center for Education Evaluation and Regional Assistance, US Department of Education, 2019); Jonathan N. Mills and Patrick J. Wolf, “The Effects of the Louisiana Scholarship Program on Student Achievement after Four Years” (EDRE Working Paper No. 2019-10, University of Arkansas, Department of Education Reform, 2019); Atila Abdulkadiroğlu, Parag A. Pathak, and Christopher R. Walters, “Free to Choose: Can School Choice Reduce Student Achievement?,” American Economic Journal: Applied Economics 10, no. 1 (2018): 175–206.

Explanations for the Negative Results

What might explain the LSP’s negative effects on student test scores? Although the LSP is not the sole private school choice program to produce negative impacts on student academic achievement, it is the only program for which an experimental evaluation has demonstrated a causal effect. However, it is important to first provide some broader context for the overall evidence (including nonexperimental evaluations) on the impact of private school choice programs on student academic achievement.

Research on existing school voucher programs in Indiana and Ohio also found negative impacts on the academic achievement outcomes of participating students. A matching study (comparing students in Indiana’s voucher program to a closely matched sample of their public school peers) found that Indiana’s private school voucher program, currently serving some 34,000 students, led to a reduction in math achievement of 15 percent of a standard deviation after the students initially entered the voucher program, but that the students’ math performance improved in later years. The researchers found no significant effect on English language arts performance. 14 R. Joseph Waddington and Mark Berends, “Impact of the Indiana Choice Scholarship Program: Achievement Effects for Students in Upper Elementary and Middle School,” Journal of Policy Analysis and Management 37, no. 4 (2018): 783–808.   Notably, the 2017 working paper version of this same evaluation found no effects on math and marginally significant positive effects on reading after four years. 15 R. Joseph Waddington and Mark Berends, “Impact of the Indiana Choice Scholarship Program: Achievement Effects for Students in Upper Elementary and Middle School” (working paper, 2017).   This change in results after the peer-review process reinforces our decision to focus on randomized controlled trials rather than matching evaluations. Matching studies are less rigorous and possibly prone to bias introduced by the model specification decisions made by researchers.  

A similarly structured matching study examining the impact of the Ohio EdChoice scholarship program on student academic achievement found that students who used a scholarship to attend a private school of choice performed worse in math and English than their matched peers who attended public schools. 16 David Figlio and Krzysztof Karbownik, Evaluation of Ohio’s EdChoice Scholarship Program: Selection, Competition, and Performance Effects (Columbus, OH: Thomas B. Fordham Institute, 2016).   Although this study found negative achievement effects on student academic achievement, it found positive competitive effects on test scores for students in nearby public schools.

Understanding the research in Indiana and Ohio provides important, but limited, context. Both of these states regulate their private school choice programs, though not to the extent that Louisiana regulates its program. Perhaps not consequently, the percentage of private schools that participate is higher in Ohio and Indiana than in Louisiana. 17 Corey A. DeAngelis, “Regulatory Compliance Costs and Private School Participation in Voucher Programs,” Journal of School Choice 14, no. 1 (2020): 95–121.   But readers should be cautious in interpreting the findings from Indiana and Ohio, because the existing studies on the impact of these school voucher programs are arguably correlational, and regulations are just one possible explanation for negative effects.

The strongest theories explaining the causal studies showing negative effects—the research concerning Louisiana—have to do with curriculum misalignment and the burdensome regulations on private schools participating in the program. First, there could be a curriculum alignment problem. Private schools have weaker incentives to teach to the test and less experience with the state’s preferred curriculum than public schools. That being so, using vouchers to enable students to attend a private school could decrease their standardized test scores without actually reducing their cognitive skills. At the same time, recent empirical evidence suggests that the theory of curricular misalignment has merit. Researchers have found that private schools are more concerned about state standardized testing mandates than requirements to take nationally norm-referenced exams. 18 Brian Kisida, Patrick J. Wolf, and Evan Rhinesmith, Views from Private Schools: Attitudes about School Choice Programs in Three States (American Enterprise Institute, January 2015).   In addition, a survey experiment has found that state testing mandates largely reduce anticipated participation in voucher programs, while nationally norm-referenced testing mandates have no statistically significant effect. 19 Corey A. DeAngelis, Lindsey M. Burke, and Patrick J. Wolf, “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from California and New York” (EDRE Working Paper No. 2019-07, University of Arkansas, Department of Education Reform, 2019).   Furthermore, every experimental voucher program evaluation following students for at least three years has found neutral to positive effects on test scores; the only exception is the LSP, which requires private schools to administer the state test.

Second, regulations might be responsible for the negative effects. Private schools participating in the LSP must administer the state standardized test, admit students on a random basis (open-admissions), and accept the voucher funding amount as payment in full (see table 2). The large negative effects of the LSP on math test scores persisted after four years of participation—a period that should have given private schools adequate time to adjust to new students and tests. Some education scholars have argued that the negative effects would have been even worse in Louisiana if not for the program’s quality-enhancing regulations—after all, they argued, the highest-quality private schools should be the most likely to not participate in the program regardless of the regulatory burden, because they want to remain exclusive. 20 Harris, “Reform Debate, Part II.”   In these scholars’ view, program regulations are more likely to deter lower-quality schools from participating in the program, and therefore increase the average quality of private schools that participate.

On the other hand, lower-quality private schools might be more likely to participate in the program regardless of the regulatory burden, because they are the most desperate for additional enrollment and funding. 21 Jason Bedrick, “The Folly of Overregulating School Choice,” Education Next , January 5, 2016.   Higher-quality private schools might be more likely to be deterred by regulations if they can afford to turn down the voucher funding and wish to remain autonomous and specialized. If so, voucher program regulations can be expected to decrease the average quality of private schools that participate. Some scholars have found, for example, that random-admissions mandates and state testing mandates are negatively associated with program participation. A 2020 study leveraged data from the 2015/16 Private School Universe Survey and found that both state testing requirements and open-admissions mandates depressed private school program participation across seven locations. 22 DeAngelis, “Regulatory Compliance Costs.”

Both sides of the debate tend to agree that program regulations reduce the quantity of schools that accept voucher students, since regulations are costs associated with participation. 23 Harris, “Reform Debate, Part II.”   Moreover, regulations such as state standardized testing requirements and random-admissions mandates might be particularly costly for the most specialized schools. If matching the unique needs of students to schools affects program success, regulations might reduce the effectiveness of voucher programs simply by reducing the number of specialized options available to families.

Table 2. Private School Choice Program Characteristics

a School must be accredited within three years of initial program participation. b Parents of students in grades 9–12 with an income greater than 220 percent of the federal poverty level may be charged additional tuition above the voucher amount. c Copay is prohibited for students from families that are at or below 200 percent of the federal poverty level.

Note: MPCP = Milwaukee Parental Choice Program, WPCP = Wisconsin Parental Choice Program, CSP = Choice Scholarship Program, LSP = Louisiana Scholarship Program, OSP = Opportunity Scholarship Program. Eligibility rate means the percent of families living in the area that have students who are eligible for the program. Private school participation rate means the percentage of private schools participating in the programs. Copay prohibited refers to the practice that a voucher must be accepted as payment-in-full.

Source: Corey A. DeAngelis, “Which Schools Participate? An Analysis of Private School Voucher Program Participation Decisions across Seven Locations” (working paper, 2019), https://ssrn.com/abstract=3309754 .

Finally, although it doesn’t explain the negative effects, the program might improve character skills that are simply not captured by standardized math and reading tests. If so, standardized test scores might not be strong proxies for long-term outcomes such as college enrollment and degree attainment. In fact, two recent reviews of the evidence find that schools’ effects on students’ test scores often do not predict schools’ effects on students’ long-term outcomes. The authors of the first study compile all the evidence linking choice schools’ effects on test scores and attainment and find that “a school choice program’s impact on test scores is a weak predictor of its impact on longer-term outcomes.” 24 Hitt, McShane, and Wolf, “Do impacts on test scores even matter? Lessons from long-run outcomes in school choice research” (American Enterprise Institute, 2018).   For example, the study finds that 61 percent of schools’ effects on math test scores—and 50 percent of their effects on reading test scores—did not successfully predict their effects on high school graduation. The second study similarly reviewed 11 studies indicating disconnects between private schools’ effects on standardized test scores and their effects on long-term outcomes such as crime and college enrollment. 25 Corey A. DeAngelis, “Divergences between Effects on Test Scores and Effects on Non-cognitive Skills,” Educational Review 2019.

But what does the evidence say? For the first time, we review the empirical evidence on the effects of school choice program regulations. Specifically, the preponderance of the evidence suggests that regulations are associated with reductions in the quantity, quality, and specialization of private schools participating in such programs. These unintended consequences could partially explain the recent negative effects of certain school choice programs on student achievement. Decreasing certain program regulations could improve the effectiveness of private school choice programs by increasing the number of meaningful options available to the families that need them the most.

Review Findings

We use the following inclusion criteria for reviewing the evidence linking private school choice program regulations to the quantity, quality, and specialization of participating private schools:

• quantitative studies (which use data to assess the types of schools that do or do not participate in voucher programs)
• studies that examine at least one of three outcomes: the quantity, quality, or specialization of private schools participating in choice programs

Regulations could have negative effects on the supply of private schools available to families. 26 Frederick M. Hess, “Does School Choice ‘Work’?,” National Affairs 5, no. 1 (Fall 2010): 35–53; Michael Q. McShane, ed., New and Better Schools: The Supply Side of School Choice (Lanham, MD: Rowman & Littlefield, 2015).   Private school leaders weigh costs and benefits when deciding whether to participate in private school choice programs each year. Because regulations are additional costs associated with participation, regulations should decrease the number of private schools that participate in choice programs.

The limited evidence on the subject supports this theory. Most of the literature linking regulations to the quantity of private schools participating in school choice programs is either correlational or merely descriptive (see table 3). Three descriptive studies examining private school choice programs in Indiana, North Carolina, Florida, and Louisiana find that private school leaders are concerned with current or future program regulations.

Megan Austin, senior researcher at American Institutes for Research, finds that the private schools electing to participate in Indiana’s Choice Scholarship Program (CSP) are most concerned about how regulations would affect their academic and religious identities. Indeed, Austin finds that schools participating in the CSP experience changes to the religious and academic composition of their students, as anticipated. 27 Megan J. Austin, “Schools’ Responses to Voucher Policy: Participation Decisions and Early Implementation Experiences in the Indiana Choice Scholarship Program,” Journal of School Choice 9, no. 3 (2015): 354–79.   Austin also finds that private schools not participating in the CSP are most concerned about the program’s procedural requirements. 28 Austin, “Schools’ Responses to Voucher Policy.”

The authors of a report evaluating North Carolina’s Opportunity Scholarship find that the top concern for private schools participating in the program is future regulations. (Eighty-two percent of the participating schools list future regulations as a concern). Regulations are also the top reason private school leaders list for declining to participate in the program. (Fifty-seven percent of nonparticipating schools list future regulations as a concern.) 29 Anna J. Egalite et al., School Leaders’ Voices: Private School Leaders’ Perspectives on the North Carolina Opportunity Scholarship Program, 2018 Update , OS Evaluation Report #6 (NC State College of Education, October 2018).

Table 3. Effect of School Choice Regulations on Private School Participation Decisions

Note: RCT = randomized controlled trial, OLS = ordinary least squares regression. ”Negative” indicates that the study found a statistically significant negative relationship between program regulations and private school participation.

Sources: Corey A. DeAngelis, Lindsey M. Burke, and Patrick J. Wolf, “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from California and New York” (EDRE Working Paper No. 2019-07, University of Arkansas, Department of Education Reform, 2019); Corey A. DeAngelis, Lindsey M. Burke, and Patrick J. Wolf, “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from Florida,” Social Science Quarterly 100, no. 6 (2019), 2316–36; David Stuit and Sy Doan, School Choice Regulations: Red Tape or Red Herring? (Washington, DC: Thomas B. Fordham Institute, 2013); Yujie Sude, Corey A. DeAngelis, and Patrick J. Wolf, “Supplying Choice: An Analysis of School Participation Decisions in Voucher Programs in Washington, DC, Indiana, and Louisiana,” Journal of School Choice 12, no. 1 (2018): 8–33; Megan J. Austin, “Schools’ Responses to Voucher Policy: Participation Decisions and Early Implementation Experiences in the Indiana Choice Scholarship Program,” Journal of School Choice 9, no. 3 (2015): 354–79; Anna J. Egalite et al., School Leaders’ Voices: Private School Leaders’ Perspectives on the North Carolina Opportunity Scholarship Program, 2018 Update , OS Evaluation Report #6 (NC State College of Education, October 2018); Brian Kisida, Patrick J. Wolf, and Evan Rhinesmith, Views from Private Schools: Attitudes about School Choice Programs in Three States (American Enterprise Institute, January 2015).

The authors of a 2015 study surveyed the leaders of nonparticipating private schools in Florida, Indiana, and Louisiana. 30 Kisida, Wolf, and Rhinesmith, Views from Private Schools .   The researchers found that 64 percent of leaders of nonparticipating private schools in Louisiana, 62 percent in Indiana, and 26 percent in Florida listed “future regulation that might come with participation” as a major reason for nonparticipation. In addition, they found that leaders participating in the LSP—the most heavily regulated of the three locations—are the most concerned about future regulations. 31 Kisida, Wolf, and Rhinesmith, Views from Private Schools .   In fact, 100 percent of the leaders of private schools participating in the LSP reported that future regulations are a general concern and 64 percent reported that future regulations are a major concern. Fifty-four percent of private school leaders participating in the CSP reported that future regulations are a major concern, while 44 percent of private school leaders participating in the Florida Tax Credit Scholarship Program—the least-regulated program of the three—reported future regulations as a major concern.

A 2018 study shows that only a third of the private schools in Louisiana participate in the heavily regulated LSP, whereas over twice that proportion of private schools participate in less-regulated programs in Washington, DC, and Indiana. 32 Yujie Sude, Corey A. DeAngelis, and Patrick J. Wolf, “Supplying Choice: An Analysis of School Participation Decisions in Voucher Programs in Washington, DC, Indiana, and Louisiana,” Journal of School Choice 12, no. 1 (2018): 8–33.   Co-founder of Basis Policy Research, David Stuit, and Associate Policy Researcher at RAND Corporation, Sy Doan, use school-level data from the 2009/10 round of the Private School Universe Survey to examine the relationship between school choice program regulatory burden and private school participation in school choice programs. 33 David Stuit and Sy Doan, School Choice Regulations: Red Tape or Red Herring? (Washington, DC: Thomas B. Fordham Institute, 2013).   After controlling for other factors that might influence a school’s decision to participate—such as school size, urbanicity, religiosity, and enrollment trends—Stuit and Doan find that increases in regulatory burdens are associated with decreases in private school participation rates. Specifically, the authors find that an increase in the regulatory burden score from 10 to 75 is associated with a 9 percentage point decrease in the likelihood of private school participation. 34 Stuit and Doan, School Choice Regulations .

Most studies examining the effects of school choice regulations are descriptive because regulations are not randomly assigned to private schools. Furthermore, the correlational literature is limited because regulatory packages are relatively similar across programs and tend not to change much over time. Two survey experiments attempt to establish causal relationships between specific voucher program regulations and private school participation. They use surveys to randomly assign different regulations—or a control condition—to private school leaders in three different states and ask them whether they would participate in new private school choice programs during the following school year. 35 Corey A. DeAngelis, Lindsey M. Burke, and Patrick J. Wolf, “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from Florida,” Social Science Quarterly 100, no. 6 (2019), 2316–36; DeAngelis, Burke, and Wolf, “Effects of Regulations: California and New York.”   The first experiment surveys private school leaders in Florida and finds that the open-admissions mandate reduces the likelihood that private school leaders say they are “certain to participate” by about 17.4 percentage points, while state standardized testing requirements reduce the likelihood that private school leaders say they are “certain to participate” by about 11.6 percentage points. 36 DeAngelis, Burke, and Wolf, “Effects of Regulations: Florida.”   Similarly, the second surveys private school leaders in California and New York and find that the open-admissions mandate reduces certain participation by about 19 percentage points, while state standardized testing requirements reduce certain participation by about 9 percentage points. 37 DeAngelis, Burke, and Wolf, “Effects of Regulations: California and New York.”   However, neither experimental study finds evidence that nationally norm-referenced testing requirements or the prohibition of parental copayment reduce private school participation overall. 38 The literature on this topic has important limitations. The two survey experiments are limited because they draw conclusions on the basis of stated—rather than revealed—preferences. See Paul A. Samuelson, “Consumption Theory in Terms of Revealed Preference,” Economica 15, no. 60 (1948): 243–53. The nonexperimental studies are limited because they are merely correlational.

In theory, regulations might be less likely to deter lower-quality private schools from participating in school choice programs than higher-quality private schools, since lower-quality schools are more in need of additional funding and enrollment—and, thus, more open to adhering to a regulatory regime in order to secure additional revenue. For their part, higher-quality private schools might be more selective when it comes to the types of voucher programs they opt into, since they are less likely to need the additional revenues to stay afloat.

The research on this question is limited since school quality is difficult to define, particularly because it is multidimensional. Families choose schools for their children on the basis of numerous priorities, including safety, culture, civic skills, religiosity, peer groups, location, and standardized test scores, among other factors. That said, eight empirical evaluations have examined the types of private schools that elect to participate in choice programs using six different measures of quality: tuition, enrollment, Google review scores, GreatSchools review scores, school safety, and standardized test scores. The preponderance of the evidence suggests that schools judged to be lower quality—on the basis of these six metrics—tend to be more likely to participate in choice programs (see table 4).

A 2018 study finds that schools with higher tuitions, enrollments, and GreatSchools review scores are less likely to participate in the Louisiana voucher program; however, the result for GreatSchools review scores is not statistically significant. 39 Sude, DeAngelis, and Wolf, “Supplying Choice.”   Two random assignment evaluations of the LSP find that the overall negative effects of the program are largely driven by private schools with lower tuition levels and enrollment trends, 40 Abdulkadiroğlu, Pathak, and Walters, “Free to Choose”; Matthew H. Lee, Jonathan N. Mills, and Patrick J. Wolf, “Heterogeneous Impacts across Schools in the First Four Years of the Louisiana Scholarship Program” (EDRE Working Paper 2019-11, University of Arkansas, Department of Education Reform, Fayetteville, AR, April 23, 2019).   suggesting that these two measures are also valid proxies for test score value-added. Furthermore, tuition levels represent the price customers are willing to pay for a school’s bundle of education services, while enrollment represents the quantity of a school’s education services demanded by families. Three other correlational studies indicate that schools with higher levels of tuition, larger enrollment, higher customer reviews, greater safety, and greater test score value-added tend to be less likely to participate in voucher programs in Milwaukee, Wisconsin; Ohio; Indiana; Colombia; and Chile. 41 Eric Bettinger et al., “School Vouchers, Labor Markets and Vocational Education” (Borradores de Economía No. 1087, Banco de la República, Colombia, 2019); Corey A. DeAngelis and Blake Hoarty, “Who Participates? An Analysis of School Participation Decisions in Two Voucher Programs in the United States” (Policy Analysis No. 848, Cato Institute, 2018); Corey A. DeAngelis and Martin F. Lueken, “Are Choice Schools Safe Schools? A Cross-Sector Analysis of K–12 Safety Policies and School Climates in Indiana” (Working Paper 2019-2, EdChoice, April 3, 2019); Cristián Sánchez, “Understanding School Competition under Voucher Regimes” (working paper, September 17, 2018), http://econweb.umd.edu/~sanchez/files/csanchez_jmp.pdf .

Although most of the correlational evidence indicates that lower-quality private schools tend to be more likely to participate in school choice programs, these studies cannot establish that program regulations are actually responsible. However, regulations are the largest cost associated with participation, in theory, and private school leaders report that program regulations are major deterrents. 42 Egalite et al., School Leaders’ Voices ; Kisida, Wolf, and Rhinesmith, Views from Private Schools .   Only two studies have randomly assigned regulations—or a control condition—to private school leaders using a survey. 43 DeAngelis, Burke, and Wolf, “Effects of Regulations: Florida”; DeAngelis, Burke, and Wolf, “Effects of Regulations: California and New York.”   One of these experiments finds limited evidence to suggest that higher-quality private schools in Florida are more likely to be deterred by various regulations. 44 DeAngelis, Burke, and Wolf, “Effects of Regulations: Florida.”

The clearest result of this experiment is that more expensive schools are more likely to be deterred by the regulation mandating that all schools accept the voucher amount as full payment. This result is intuitive: it is much more costly for a school with tuition of $20,000 to accept a $6,000 voucher as payment in full than for a school with tuition of $10,000 to do so. In addition, the researchers’ model, with all controls, finds that a $1,000 increase in tuition is associated with a 1.4 percentage point increase in the magnitude of the negative effect of a state standardized testing mandate on intended program participation. The researchers also find that a 10 percentage point increase in enrollment growth from 2014 to 2016 is associated with a 2 percentage point increase in the magnitude of the negative effect of the open-admissions regulation on intended program participation.

The survey experiment examining the relationship between regulations and private school participation in voucher programs in California and New York mostly does not find heterogeneous effects by school quality. However, one marginally significant result suggests that a one-point increase in Google review scores (on a five-point rating scale) is associated with a 14.5 percentage point increase in the magnitude of the negative effect of the state testing mandate on anticipated program participation.

Table 4. Effect of School Choice Regulations on Quality of Participating Private Schools

Note: RCT = randomized controlled trial, OLS = ordinary least squares regression. “Negative” indicates that the study found a statistically significant negative relationship between program regulations and the quality of the participating private schools. “Null” indicates that the study found no relationship between program regulations and the quality of the participating private schools. “Null to negative” indicates that the study found null to negative relationships between program regulations and the quality of the participating private schools.

Sources: Corey A. DeAngelis, Lindsey M. Burke, and Patrick J. Wolf, “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from California and New York” (EDRE Working Paper No. 2019-07, University of Arkansas, Department of Education Reform, 2019); Corey A. DeAngelis, Lindsey M. Burke, and Patrick J. Wolf, “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from Florida,” Social Science Quarterly 100, no. 6 (2019), 2316–36; Atila Abdulkadiroğlu, Parag A. Pathak, and Christopher R. Walters, “Free to Choose: Can School Choice Reduce Student Achievement?,” American Economic Journal: Applied Economics 10, no. 1 (2018): 175–206; Matthew H. Lee, Jonathan N. Mills, and Patrick J. Wolf, “Heterogeneous Impacts across Schools in the First Four Years of the Louisiana Scholarship Program” (EDRE Working Paper 2019-11, University of Arkansas, Department of Education Reform, Fayetteville, AR, April 23, 2019); Corey A. DeAngelis and Blake Hoarty, “Who Participates? An Analysis of School Participation Decisions in Two Voucher Programs in the United States” (Policy Analysis No. 848, Cato Institute, 2018); Corey A. DeAngelis and Martin F. Lueken, “Are Choice Schools Safe Schools? A Cross-Sector Analysis of K–12 Safety Policies and School Climates in Indiana” (Working Paper 2019-2, EdChoice, April 3, 2019); Eric Bettinger et al., “School Vouchers, Labor Markets and Vocational Education” (Borradores de Economía No. 1087, Banco de la República, Colombia, 2019); Cristián Sánchez, “Understanding School Competition under Voucher Regimes” (working paper, September 17, 2018), http://econweb.umd.edu/~sanchez/files/csanchez_jmp.pdf; Yujie Sude, Corey A. DeAngelis, and Patrick J. Wolf, “Supplying Choice: An Analysis of School Participation Decisions in Voucher Programs in Washington, DC, Indiana, and Louisiana,” Journal of School Choice 12, no. 1 (2018): 8–33.

Specialization

As Michael McShane, director of national research at EdChoice, theorized, “overregulation can have a chilling effect on diversity and innovation.” 45 Michael Q. McShane, Rethinking Regulation: Overseeing Performance in a Diversifying Educational Ecosystem (Indianapolis: EdChoice, May 2018).   Regulations might lead to homogenization in the private school market for a couple of reasons. 46 Lindsey M. Burke, “Avoiding the ‘‘Inexorable Push toward Homogenization’ in School Choice: Education Savings Accounts as Hedges against Institutional Isomorphism,” Journal of School Choice 10, no. 4 (2016): 560–78.   First, because program regulations largely mirror regulations in traditional public schools, the switching costs associated with program participation will be higher for the most specialized private schools. Private schools that already operate similarly to traditional public schools, on the other hand, will tend to face lower switching costs associated with program requirements. Second, some of the regulations associated with program participation make it particularly difficult for private schools to remain specialized. For example, the Louisiana voucher program requires that participating private schools use random admissions processes, which could make it challenging for schools to maintain high academic standards or specialized missions. 47 “Louisiana Scholarship Program,” EdChoice, accessed May 19, 2020, https://www.edchoice.org/school-choice/programs/louisiana-scholarship-program/ .   Private schools participating in the LSP must also administer the state’s standardized tests, which could increase the costs associated with deviating from the government’s uniform curriculum. Private schools participating in the Milwaukee Parental Choice Program must use random admissions processes and must allow students to opt out of religious programs. 48 “Wisconsin—Milwaukee Parental Choice Program,” EdChoice, accessed May 19, 2020, https://www.edchoice.org/school-choice/programs/wisconsin-milwaukee-parental-choice-program/ .

Again, most of the evidence on the subject of specialization is merely correlational. However, just about all the correlational evidence indicates that more-specialized schools tend to be less likely to participate in voucher programs (see table 5). Four descriptive studies find that a significant share of private school leaders report that they are concerned about school choice programs’ effects on their schools’ specialized identities. 49 Austin, “Schools’ Responses to Voucher Policy”; Megan J. Austin, “Organizational and Social Costs of Schools’ Participation in a Voucher Program,” in School Choice at the Crossroads: Research Perspectives , ed. Mark Berends, R. Joseph Waddington, and John Schoenig (New York: Routledge, 2019); Egalite et al., School Leaders’ Voices ; Kisida, Wolf, and Rhinesmith, Views from Private Schools .   One 2015 study finds that 55 percent of private school leaders in Louisiana, 63 percent in Indiana, and 39 percent in Florida were concerned about school choice programs having an effect on their “independence, character, or identity.” 50 Kisida, Wolf, and Rhinesmith, Views from Private Schools .   Megan Austin has found that “schools choosing to participate in the Indiana Choice Scholarship Program were most concerned with how their academic and religious identity would be affected.” 51 Austin, “Schools’ Responses to Voucher Policy.”   She interviewed principals of 10 Catholic schools that had chosen to participate in the program and finds additional costs associated with adapting to the needs of new students while maintaining school identity. 52 Austin, “Organizational and Social Costs.”   The authors of a 2018 study find that 14 to 18 percent of private school leaders in North Carolina reported concerns about the voucher program’s effects on their school’s identity. 53 Egalite et al., School Leaders’ Voices .

A 2019 study finds that private schools identifying as “regular schools” are more likely than nonregular schools to participate in school choice programs in Indiana, Louisiana, North Carolina, Ohio, Wisconsin, and Washington, DC. 54 Corey A. DeAngelis, “Which Schools Participate? An Analysis of Private School Voucher Program Participation Decisions across Seven Locations” (working paper, 2019), https://ssrn.com/abstract=3309754 .   Overall, schools that identify as primarily serving students with special needs, schools that focus on early childhood education, and alternative schools are less likely to participate in voucher programs than schools that identify as regular. Private schools that focus on supporting homeschooled students are less likely to participate than those that do not, and non-coeducational schools are less likely to participate than coeducational schools. Two studies have found that individual private schools in Indiana, Florida, Louisiana, Ohio, and Washington, DC, tend to be less likely to identify as specialized or alternative—and more likely to identify as regular—when they switch into voucher program environments. 55 Corey A. DeAngelis and Lindsey M. Burke, “Does Regulation Induce Homogenisation? An Analysis of Three Voucher Programmes in the United States,” Educational Research and Evaluation 23, no. 7–8 (2017): 311–27; Corey A. DeAngelis and Lindsey M. Burke, “Does Regulation Reduce Specialization? Examining the Impact of Regulations on Private Schools of Choice in Five Locations” (Working Paper 2019-1, EdChoice, March 14, 2019).   A 2019 study finds that individual private schools in Indiana, Louisiana, and Washington, DC, are around two percentage points less likely to report that they focus on supporting homeschooling after they switch into voucher program environments. 56 Corey A. DeAngelis and Angela K. Dills, “Is School Choice a Trojan Horse? The Effects of School Choice Laws on Homeschool Prevalence,” Peabody Journal of Education 94, no. 3 (2019): 342–54.

Two survey experiments address this question. One finds that the random admissions mandate has around a 25 percentage point negative effect on expected participation for nonregular (specialized) private schools and around a 17 percentage point negative effect on expected participation for regular (nonspecialized) private schools. 57 DeAngelis, Burke, and Wolf, “Effects of Regulations: California and New York.”   However, while the difference of around 8 percentage points suggests that the random admissions regulation is more costly for specialized private schools, it is not statistically significant. The second study similarly finds that the negative effects of school choice regulations on expected program participation do not differ by private school specialization. 58 DeAngelis, Burke, and Wolf, “Effects of Regulations: Florida.”

Table 5. Effect of School Choice Regulations on Specialization of Participating Private Schools

a While Egalite et al. find that 14 to 18 percent of private school leaders in North Carolina report that the voucher program’s effects on their school’s identity is a concern, 82 to 86 percent indicate that this is not a concern.

Note: RCT = randomized controlled trial, OLS = ordinary least squares regression. “Negative” indicates that the study found a statistically significant negative relationship between program regulations and the specialization of the participating private schools. “Null” indicates that the study found no relationship between program regulations and the specialization of the participating private schools. Null to negative indicates that the study found null to negative relationships between program regulations and the specialization of the participating private schools.

Sources: Corey A. DeAngelis, Lindsey M. Burke, and Patrick J. Wolf, “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from California and New York” (EDRE Working Paper No. 2019-07, University of Arkansas, Department of Education Reform, 2019); Corey A. DeAngelis, Lindsey M. Burke, and Patrick J. Wolf, “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from Florida,” Social Science Quarterly 100, no. 6 (2019): 2316–36; Corey A. DeAngelis and Lindsey M. Burke, “Does Regulation Reduce Specialization? Examining the Impact of Regulations on Private Schools of Choice in Five Locations” (Working Paper 2019-1, EdChoice, March 14, 2019); Corey A. DeAngelis and Lindsey M. Burke, “Does Regulation Induce Homogenisation? An Analysis of Three Voucher Programmes in the United States,” Educational Research and Evaluation 23, no. 7–8 (2017): 311–27; Corey A. DeAngelis and Angela K. Dills, “Is School Choice a Trojan Horse? The Effects of School Choice Laws on Homeschool Prevalence,” Peabody Journal of Education 94, no. 3 (2019): 342–54; Corey A. DeAngelis, “Which Schools Participate? An Analysis of Private School Voucher Program Participation Decisions across Seven Locations” (working paper, 2019), https://ssrn.com/abstract=3309754; Megan J. Austin, “Organizational and Social Costs of Schools’ Participation in a Voucher Program,” in School Choice at the Crossroads: Research Perspectives , ed. Mark Berends, R. Joseph Waddington, and John Schoenig (New York: Routledge, 2019); Megan J. Austin, “Schools’ Responses to Voucher Policy: Participation Decisions and Early Implementation Experiences in the Indiana Choice Scholarship Program,” Journal of School Choice 9, no. 3 (2015): 354–79; Anna J. Egalite et al., School Leaders’ Voices: Private School Leaders’ Perspectives on the North Carolina Opportunity Scholarship Program, 2018 Update , OS Evaluation Report #6 (NC State College of Education, October 2018); Brian Kisida, Patrick J. Wolf, and Evan Rhinesmith, Views from Private Schools: Attitudes about School Choice Programs in Three States (American Enterprise Institute, January 2015).

Conclusion and Policy Implications

If a family is unhappy with the education services provided by their residentially assigned public school, they generally only have four options: (1) pay for a private school out of pocket while still paying for the public school through property taxes, (2) incur the costs associated with homeschooling while still paying for the public school through property taxes, (3) move to a different residence that is assigned to a better public school, or (4) tell the residentially assigned public school to change and hope that things get better soon. Because each of these options is highly costly for families—especially for low-income households—either in terms of actual financial costs or of time lost while waiting for the public school to change, economists would argue that residentially assigned public schools hold significant monopoly power in the education market. 59 Milton Friedman, “The Role of Government in Education,” in Economics and the Public Interest , ed. Robert A. Solo (New Brunswick, NJ: Rutgers University Press, 1955).   In fact, the costs of these options are so high that parents have even gone to jail for trying to get their children into better public schools by lying about their residencies. 60 Erika Sanzi, “While Rich People Bribe Their Kids’ Way into College, Parents of Color Sit in Jail for Wanting Better Schools,” Education Post , March 13, 2019.

Private school choice programs decrease the costs associated with the first option by allowing families to use a fraction of their public education dollars to send their children to private schools. In theory, private school choice is expected to improve student outcomes by introducing competitive pressures into the market for education and putting power into the hands of consumers. 61 John E. Chubb and Terry M. Moe, “Politics, Markets, and the Organization of Schools,” American Political Science Review 82, no. 4 (1988): 1065–87; Corey A. DeAngelis, “Is Public Schooling a Public Good? An Analysis of Schooling Externalities” (Policy Analysis No. 842, Cato Institute, May 9, 2018); Caroline M. Hoxby, ed., The Economics of School Choice (Chicago: University of Chicago Press, 2007).   Families want their children to receive great educations, and parents are better positioned to understand their children’s education needs than distant bureaucrats. Public and private schools must cater to the needs of families if they wish to keep their doors open when families can vote with their feet. Private school choice programs might also lead to better education outcomes by improving matches between schools and students. 62 DeAngelis and Holmes Erickson, “What Leads to Successful School Choice Programs? A Review of the Theories and Evidence,” Cato Journal 38, no. 1 (2018): 247–63.

This review of the academic literature examines the impact of regulations on the quantity, quality, and specialization of private schools that decide to participate in school choice programs. On balance, the literature suggests that regulations are a net negative for school choice program design. Seven studies consider the relationship between regulations and private school participation in a school choice program, and all seven find negative effects, suggesting that onerous regulations reduce the likelihood of school participation. Eight studies look at the relationship between regulations and school quality; seven find that regulations could reduce the quality of the private schools that participate in school choice programs, and one finds null effects. Finally, ten studies examine the relationship between regulations and school specialization; seven studies suggest negative effects and three find null effects.

These findings also offer some possible explanations for the LSP’s persistent and large negative effects on math test scores. First, private schools might have a comparative advantage at shaping character skills that are not easily captured by standardized test scores. In other words, standardized math and reading test scores may not be strong proxies for students’ long-term success. 63 DeAngelis, “Divergences”; Hitt, McShane, and Wolf, “Do impacts on test scores”.   Public schools have stronger incentives to teach to the test—and more experience with test taking—than private schools, meaning private school choice programs could decrease performance on standardized tests without actually negatively affecting learning in the short run.

However, it is also possible that students participating in the LSP are learning less than children in public schools. Because this is possible, we should be especially concerned about how the design of school choice programs could influence their effectiveness. The empirical evidence on the topic tends to suggest that regulations unintentionally decrease the quantity, quality, and specialization of private schools that elect to participate in choice programs. Of course, this doesn’t mean that policymakers should get rid of all school choice program regulations; instead, they need to more carefully weigh the intended benefits of regulations against the unintended—but realized—costs of regulations.

The most rigorous evidence suggests that while the open-admissions mandate aims to achieve equality, it has the largest negative effects on private school participation. The unintended result of the open- admissions mandate is the exact opposite of its intended effect. The regulation actually leads to less equality because fewer private schools participate, meaning that the least advantaged groups of students will have virtually no chance of attending those schools, while children from high-income families are still able to attend without financial assistance. Two survey experiments find that the state testing mandate significantly reduces the number of private schools available to students, whereas the nationally norm-referenced testing mandate is not associated with any significant reduction in options. In other words, if a testing regulation is necessary for the appearance of accountability to the public, policymakers should choose nationally norm-referenced tests to avoid the demonstrated unintended consequences of mandating the state test. The negative effects of state testing mandates are especially important to consider since research consistently finds that families do not strongly value standardized testing when they choose schools. 64 Jason Bedrick and Lindsey M. Burke, Surveying Florida Scholarship Families: Experiences and Satisfaction with Florida’s Tax-Credit Scholarship Program (Indianapolis: EdChoice, October 2018).

The evaluation of the LSP was the first experiment in the world to find statistically significant negative effects of a private school voucher program on student test scores. The negative effects were large. The LSP also has the two most intrusive program regulations—the random-admissions mandate and the requirement that private schools administer the state standardized tests. The LSP also mandates that private schools accept the voucher amount as full payment, which keeps the most expensive private schools from participating in the program. Only a third of the private schools in Louisiana elect to participate in the LSP, whereas over twice that proportion tend to participate in less-regulated programs. In addition, schools with declining enrollment and lower tuitions—proxies for school quality—are more likely to participate in the LSP, perhaps because they most need additional voucher funding.

Policymakers should consider the real costs associated with well-meaning regulations. The empirical evidence tends to suggest that regulations reduce the quantity, quality, and specialization of the private schools that participate in school choice programs. Policymakers could increase the number of meaningful options available to families by reducing top-down regulations of private school choice programs. Giving families real options—by avoiding onerous regulations—could increase the chances of success for the children that are most in need of better education options. If regulations reduce the variety and quality of private schools that choose to participate in school choice programs, they cut against the primary purpose of education choice: to provide more families with more options when it comes to their children’s education.

Much more research is needed on the impact of regulations on the supply and quality of private schools choosing to participate or not participate in a private school choice program. And policymakers and government officials will need to pay particular attention to the design of school choice programs and the regulations that govern them as education becomes more piecemeal and customized in the years to come. New modes of K–12 education delivery are unfolding every year, from new approaches to education financing with education savings accounts to changes in delivery through micro-schooling, online learning, private tutoring, and homeschooling co-ops, among other options. How the public and governments conceive of accountability, and how they understand the impact of specific regulations on these options, will shape the education landscape for decades.

Abdulkadiroğlu, Pathak, and Walters, “Free to Choose.”

Austin, Megan J. “Organizational and Social Costs of Schools’ Participation in a Voucher Program.” in School Choice at the Crossroads: Research Perspectives . Ed. Mark Berends, R. Joseph Waddington, and John Schoenig (New York: Routledge. 2019).

Austin, Megan J. “Schools’ Responses to Voucher Policy: Participation Decisions and Early Implementation Experiences in the Indiana Choice Scholarship Program.” Journal of School Choice 9. No. 3 (2015): 354–79.

Barnard, John et al. “Principal Stratification Approach to Broken Randomized Experiments: A Case Study of School Choice Vouchers in New York City.” Journal of the American Statistical Association 98. No. 462 (2003): 299–323.

Bedrick, Jason and Lindsey M. Burke. Surveying Florida Scholarship Families: Experiences and Satisfaction with Florida’s Tax-Credit Scholarship Program (Indianapolis: EdChoice. October 2018).

Bedrick, Jason. “Leave School Choice to the States.” TownHall.com . April 16, 2015.

Bedrick, Jason. “The Folly of Overregulating School Choice.” Education Next . January 5, 2016.

Bettinger, Eric et al. “School Vouchers, Labor Markets and Vocational Education” (Borradores de Economía No. 1087. Banco de la República. Colombia, 2019).

Burke, Lindsey M. “Avoiding the ‘‘Inexorable Push toward Homogenization’ in School Choice: Education Savings Accounts as Hedges against Institutional Isomorphism.” Journal of School Choice 10. No. 4 (2016): 560–78.

Chingos, Matthew M. et al. “The Effects of Means-Tested Private School Choice Programs on College Enrollment and Graduation” (Research Report. Urban Institute. Washington, DC. July 2019).

Chubb, John E. and Terry M. Moe. “Politics, Markets, and the Organization of Schools.” American Political Science Review 82. No. 4 (1988): 1065–87.

Cowen, Joshua M. “School Choice as a Latent Variable: Estimating the ‘Complier Average Causal Effect’ of Vouchers in Charlotte.” Policy Studies Journal 36. No. 2 (2008): 301–15.

DeAngelis, Corey A. and Holmes Erickson. “What Leads to Successful School Choice Programs? A Review of the Theories and Evidence.” Cato Journal 38. No. 1 (2018): 247–63.

DeAngelis, Corey A. “Divergences between Effects on Test Scores and Effects on Non-cognitive Skills.” Educational Review 2019.

DeAngelis, Corey A. “Do Self-Interested Schooling Selections Improve Society? A Review of the Evidence.” Journal of School Choice 11. No. 4 (2017): 546–58.

DeAngelis, Corey A. “Is Public Schooling a Public Good? An Analysis of Schooling Externalities” (Policy Analysis No. 842. Cato Institute. May 9, 2018).

DeAngelis, Corey A. “Regulatory Compliance Costs and Private School Participation in Voucher Programs.” Journal of School Choice 14. No. 1 (2020): 95–121.

DeAngelis, Corey A. “Which Schools Participate? An Analysis of Private School Voucher Program Participation Decisions across Seven Locations” (Working paper. 2019). https://ssrn.com/abstract=3309754 .

DeAngelis, Corey A. and Angela K. Dills. “Is School Choice a Trojan Horse? The Effects of School Choice Laws on Homeschool Prevalence.” Peabody Journal of Education 94. No. 3 (2019): 342–54.

DeAngelis, Corey A. and Blake Hoarty. “Who Participates? An Analysis of School Participation Decisions in Two Voucher Programs in the United States” (Policy Analysis No. 848. Cato Institute. 2018).

DeAngelis, Corey A. and Lindsey M. Burke. “Does Regulation Induce Homogenisation? An Analysis of Three Voucher Programmes in the United States.” Educational Research and Evaluation 23. No. 7–8 (2017): 311–27.

DeAngelis, Corey A. and Lindsey M. Burke. “Does Regulation Reduce Specialization? Examining the Impact of Regulations on Private Schools of Choice in Five Locations” (Working Paper 2019-1. EdChoice. March 14, 2019).

DeAngelis, Corey A. and Martin F. Lueken. “Are Choice Schools Safe Schools? A Cross-Sector Analysis of K–12 Safety Policies and School Climates in Indiana” (Working Paper 2019-2. EdChoice. April 3, 2019).

DeAngelis, Corey A., Lindsey M. Burke, and Patrick J. Wolf. “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from California and New York” (EDRE Working Paper No. 2019-07. University of Arkansas. Department of Education Reform. 2019).

DeAngelis, Corey A., Lindsey M. Burke, and Patrick J. Wolf. “The Effects of Regulations on Private School Choice Program Participation: Experimental Evidence from Florida.” Social Science Quarterly 100. No. 6 (2019). 2316–36.

EdChoice. The ABCs of School Choice: The Comprehensive Guide to Every Private School Choice Program in America . 2020 ed.

Egalite, Anna J. “Measuring Competitive Effects from School Voucher Programs: A Systematic Review.” Journal of School Choice 7. No. 4 (2013): 443–64.

Egalite, Anna J. et al. School Leaders’ Voices: Private School Leaders’ Perspectives on the North Carolina Opportunity Scholarship Program, 2018 Update . OS Evaluation Report #6 (NC State College of Education. October 2018).

Figlio, David and Krzysztof Karbownik. Evaluation of Ohio’s EdChoice Scholarship Program: Selection, Competition, and Performance Effects (Columbus, OH: Thomas B. Fordham Institute. 2016).

Foreman, Leesa M. “Educational Attainment Effects of Public and Private School Choice.” Journal of School Choice 11. No. 4 (2017): 642–54.

Friedman, Milton. “The Role of Government in Education.” in Economics and the Public Interest . Ed. Robert A. Solo (New Brunswick, NJ: Rutgers University Press. 1955).

Greene, Jay P. “The Effect of School Choice: An Evaluation of the Charlotte Children’s Scholarship Fund Program.” Civic Report 12 (2000): 1–15.

Greene, Jay P., Paul E. Peterson, and Jiangtao Du. “Effectiveness of School Choice: The Milwaukee Experiment.” Education and Urban Society 31. No. 2 (1999): 190–213.

Harris, Douglas. “The Reform Debate, Part II: The Difference between Charter and Voucher Schools.” Education Week . November 11, 2015.

Hess, Frederick M. “Does School Choice ‘Work’?” National Affairs 5. No. 1 (Fall 2010): 35–53.

Hitt, McShane, and Wolf. “Do impacts on test scores even matter? Lessons from long-run outcomes in school choice research” (American Enterprise Institute. 2018).

Howell, William G. et al. “School Vouchers and Academic Performance: Results from Three Randomized Field Trials.” Journal of Policy Analysis and Management 21. No. 2 (2002): 191–217.

Hoxby, Caroline M. ed. The Economics of School Choice (Chicago: University of Chicago Press. 2007).

Jin, Hui, John Barnard, and Donald B. Rubin. “A Modified General Location Model for Noncompliance with Missing Data: Revisiting the New York City School Choice Scholarship Program Using Principal Stratification.” Journal of Educational and Behavioral Statistics 35. No. 2 (2010): 154–73.

Kisida, Brian, Patrick J. Wolf, and Evan Rhinesmith. Views from Private Schools: Attitudes about School Choice Programs in Three States (American Enterprise Institute. January 2015).

Lee, Matthew H., Jonathan N. Mills, and Patrick J. Wolf. “Heterogeneous Impacts across Schools in the First Four Years of the Louisiana Scholarship Program” (EDRE Working Paper 2019-11. University of Arkansas. Department of Education Reform. Fayetteville, AR. April 23, 2019).

“Louisiana Scholarship Program.” EdChoice. Accessed May 19, 2020. https://www.edchoice.org/school-choice/programs/louisiana-scholarship-program/ .

Machan, Tibor R. “Government Regulation of Business: The Moral Arguments.” Foundation for Economic Education. July 1, 1988.

McShane, Michael Q. ed. New and Better Schools: The Supply Side of School Choice (Lanham, MD: Rowman & Littlefield. 2015).

McShane, Michael Q. Rethinking Regulation: Overseeing Performance in a Diversifying Educational Ecosystem (Indianapolis: EdChoice. May 2018).

Mills, Jonathan N. “The Effectiveness of Cash Transfers as a Policy Instrument in K-16 Education” (University of Arkansas Theses and Dissertations. 2015).

Mills, Jonathan N. and Patrick J. Wolf. “The Effects of the Louisiana Scholarship Program on Student Achievement after Four Years” (EDRE Working Paper No. 2019-10. University of Arkansas. Department of Education Reform. 2019).

Mills, Jonathan N. and Patrick J. Wolf. “Vouchers in the Bayou: The Effects of the Louisiana Scholarship Program on Student Achievement after 2 Years.” Educational Evaluation and Policy Analysis 39. No. 3 (2017): 464–84.

Rouse, Cecilia Elena. “Private School Vouchers and Student Achievement: An Evaluation of the Milwaukee Parental Choice Program.” Quarterly Journal of Economics 113. No. 2 (1998): 553–602.

Samuelson, Paul A. “Consumption Theory in Terms of Revealed Preference.” Economica 15. No. 60 (1948): 243–53.

Sánchez, Cristián. “Understanding School Competition under Voucher Regimes” (Working paper. September 17, 2018). http://econweb.umd.edu/~sanchez/files/csanchez_jmp.pdf .

Sanzi, Erika. “While Rich People Bribe Their Kids’ Way into College, Parents of Color Sit in Jail for Wanting Better Schools.” Education Post . March 13, 2019.

Stuit, David and Sy Doan. School Choice Regulations: Red Tape or Red Herring? (Washington, DC: Thomas B. Fordham Institute. 2013).

Sude, Yujie, Corey A. DeAngelis, and Patrick J. Wolf. “Supplying Choice: An Analysis of School Participation Decisions in Voucher Programs in Washington, DC, Indiana, and Louisiana.” Journal of School Choice 12. No. 1 (2018): 8–33.

Swanson, Elise. “Can We Have It All? A Review of the Impacts of School Choice on Racial Integration.” Journal of School Choice 11. No. 4 (2017): 507–26.

Waddington, R. Joseph and Mark Berends. “Impact of the Indiana Choice Scholarship Program: Achievement Effects for Students in Upper Elementary and Middle School.” Journal of Policy Analysis and Management 37. No. 4 (2018): 783–808.

Webber, Ann et al. Evaluation of the DC Opportunity Scholarship Program: Impacts Three Years after Students Applied . NCEE 2019-4006 (National Center for Education Evaluation and Regional Assistance. US Department of Education. 2019).

“Wisconsin—Milwaukee Parental Choice Program.” EdChoice. Accessed May 19, 2020. https://www.edchoice.org/school-choice/programs/wisconsin-milwaukee-parental-choice-program/ .

Wolf, Patrick J. “Civics Exam: Schools of Choice Boost Civic Values.” Education Next 7. No. 3 (2007): 66–73.

Wolf, Patrick J. et al. “School Vouchers and Student Outcomes: Experimental Evidence from Washington, DC.” Journal of Policy Analysis and Management 32. No. 2 (2013): 246–70.

Wolf, Patrick J. et al. Evaluation of the DC Opportunity Scholarship Program: Final Report . NCEE 2010-4018 (National Center for Education Evaluation and Regional Assistance. US Department of Education. 2010).

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• Regulation and Entrepreneurship: Theory, Impacts, and Implications
• Regulation and the Perpetuation of Poverty in the US and Senegal
• Social Trust and Regulation: A Time-Series Analysis of the United States
• Regulation and the Shadow Economy
• An Introduction to the Effect of Regulation on Employment and Wages
• Occupational Licensing: A Barrier to Opportunity and Prosperity
• Gender, Race, and Earnings: The Divergent Effect of Occupational Licensing on the Distribution of Earnings and on Access to the Economy
• How Can Certificate-of-Need Laws Be Reformed to Improve Access to Healthcare?
• Land Use Regulation and Housing Affordability
• Building Energy Codes: A Case Study in Regulation and Cost-Benefit Analysis
• The Tradeoffs between Energy Efficiency, Consumer Preferences, and Economic Growth
• Cooperation or Conflict: Two Approaches to Conservation
• Retail Electric Competition and Natural Monopoly: The Shocking Truth
• Governance for Networks: Regulation by Networks in Electric Power Markets in Texas
• Net Neutrality: Internet Regulation and the Plans to Bring It Back
• “Blue Laws” and Other Cases of Bootlegger/Baptist Influence in Beer Regulation
• Smoke or Vapor? Regulation of Tobacco and Vaping
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The role and impact of private schools in developing countries. Education rigorous literature review.

Related Papers

David Longfield

We are grateful to the “Private Schools Rigorous Review Team” (henceforth “Team”) for their reply to Tooley and Longfield, (2015), itself a response to the Team’s DFID-commissioned “Rigorous Review” (Day Ashley et al., 2014). In our Rejoinder we have confined our remark to three areas. First, we are pleased that the Team acknowledges it made eight of the errors and misrepresentations we highlighted in our Response (section 1). However we are disappointed they did not address more of the errors/misrepresentations we had pointed out. Second, we are also disappointed that the Team forbids our reformulation of two (out of 17) of their assumptions (section 2), even though it turns out that others had been allowed to make changes earlier. Third, we also question the way in which the Team has tried to reduce the impact of some of the studies included in the research sample, now that they seem to point in favour of private schools (section 3).

Richard A Batley

This paper presents a rigorous review of the recent good quality evidence on the role and impact of private schools on the education of school-aged children in developing countries. The emphasis is on private schools involved in the delivery of education for the poor in DFID priority countries including, but not restricted to, low-fee private schools. The strength of the evidence is assessed and gaps are identified which highlight areas for further research.

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Education Literature Review: Education Literature Review

What does this guide cover.

Writing the literature review is a long, complex process that requires you to use many different tools, resources, and skills.

This page provides links to the guides, tutorials, and webinars that can help you with all aspects of completing your literature review.

The Basic Process

These resources provide overviews of the entire literature review process. Start here if you are new to the literature review process.

• Literature Reviews Overview : Writing Center
• How to do a Literature Review : Library
• Video: Common Errors Made When Conducting a Lit Review (YouTube)  

The Role of the Literature Review

Your literature review gives your readers an understanding of the evolution of scholarly research on your topic.

In your literature review you will:

• survey the scholarly landscape
• provide a synthesis of the issues, trends, and concepts
• possibly provide some historical background

Review the literature in two ways:

• Section 1: reviews the literature for the Problem
• Section 3: reviews the literature for the Project

The literature review is NOT an annotated bibliography. Nor should it simply summarize the articles you've read. Literature reviews are organized thematically and demonstrate synthesis of the literature.

For more information, view the Library's short video on searching by themes:

Short Video: Research for the Literature Review

(4 min 10 sec) Recorded August 2019 Transcript 

Search for Literature

The iterative process of research:

• Find an article.
• Read the article and build new searches using keywords and names from the article.
• Mine the bibliography for other works.
• Use “cited by” searches to find more recent works that reference the article.
• Repeat steps 2-4 with the new articles you find.

These are the main skills and resources you will need in order to effectively search for literature on your topic:

• Subject Research: Education by Jon Allinder Last Updated Aug 7, 2023 2713 views this year
• Keyword Searching: Finding Articles on Your Topic by Lynn VanLeer Last Updated Sep 12, 2023 14329 views this year
• Google Scholar by Jon Allinder Last Updated Aug 16, 2023 8926 views this year
• Quick Answer: How do I find books and articles that cite an article I already have?
• Quick Answer: How do I find a measurement, test, survey or instrument?

Video: Education Databases and Doctoral Research Resources

(6 min 04 sec) Recorded April 2019 Transcript 

Staying Organized

The literature review requires organizing a variety of information. The following resources will help you develop the organizational systems you'll need to be successful.

• Organize your research
• Citation Management Software

You can make your search log as simple or complex as you would like.  It can be a table in a word document or an excel spread sheet.  Here are two examples.  The word document is a basic table where you can keep track of databases, search terms, limiters, results and comments.  The Excel sheet is more complex and has additional sheets for notes, Google Scholar log; Journal Log, and Questions to ask the Librarian.  

• Search Log Example Sample search log in Excel
• Search Log Example Sample search log set up as a table in a word document.
• Literature Review Matrix with color coding Sample template for organizing and synthesizing your research

Writing the Literature Review

The following resources created by the Writing Center and the Academic Skills Center support the writing process for the dissertation/project study. 

• Critical Reading
• What is Synthesis 
• Walden Templates
• Quick Answer: How do I find Walden EdD (Doctor of Education) studies?
• Quick Answer: How do I find Walden PhD dissertations?

Beyond the Literature Review

The literature review isn't the only portion of a dissertation/project study that requires searching. The following resources can help you identify and utilize a theory, methodology, measurement instruments, or statistics.

• Education Theory by Jon Allinder Last Updated May 1, 2022 307 views this year
• Tests & Measures in Education by Kimberly Burton Last Updated Nov 18, 2021 17 views this year
• Education Statistics by Jon Allinder Last Updated Feb 22, 2022 20 views this year
• Office of Research and Doctoral Services

Books and Articles about the Lit Review

The following articles and books outline the purpose of the literature review and offer advice for successfully completing one.

• Chen, D. T. V., Wang, Y. M., & Lee, W. C. (2016). Challenges confronting beginning researchers in conducting literature reviews. Studies in Continuing Education, 38(1), 47-60. https://doi.org/10.1080/0158037X.2015.1030335 Proposes a framework to conceptualize four types of challenges students face: linguistic, methodological, conceptual, and ontological.
• Randolph, J.J. (2009). A guide to writing the dissertation literature review. Practical Assessment, Research & Evaluation 14(13), 1-13. Provides advice for writing a quantitative or qualitative literature review, by a Walden faculty member.
• Torraco, R. J. (2016). Writing integrative literature reviews: Using the past and present to explore the future. Human Resource Development Review, 15(4), 404–428. https://doi.org/10.1177/1534484316671606 This article presents the integrative review of literature as a distinctive form of research that uses existing literature to create new knowledge.
• Wee, B. V., & Banister, D. (2016). How to write a literature review paper?. Transport Reviews, 36(2), 278-288. http://doi.org/10.1080/01441647.2015.1065456 Discusses how to write a literature review with a focus on adding value rather and suggests structural and contextual aspects found in outstanding literature reviews.
• Winchester, C. L., & Salji, M. (2016). Writing a literature review. Journal of Clinical Urology, 9(5), 308-312. https://doi.org/10.1177/2051415816650133 Reviews the use of different document types to add structure and enrich your literature review and the skill sets needed in writing the literature review.
• Xiao, Y., & Watson, M. (2017). Guidance on conducting a systematic literature review. Journal of Planning Education and Research. https://doi.org/10.1177/0739456X17723971 Examines different types of literature reviews and the steps necessary to produce a systematic review in educational research.

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Methodology

• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
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• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
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Research bias

• Optimism bias
• Cognitive bias
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A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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• Open access
• Published: 06 December 2022

What improves access to primary healthcare services in rural communities? A systematic review

• Zemichael Gizaw 1 ,
• Tigist Astale 2 &
• Getnet Mitike Kassie 2  

BMC Primary Care volume  23 , Article number:  313 ( 2022 ) Cite this article

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To compile key strategies from the international experiences to improve access to primary healthcare (PHC) services in rural communities. Different innovative approaches have been practiced in different parts of the world to improve access to essential healthcare services in rural communities. Systematically collecting and combining best experiences all over the world is important to suggest effective strategies to improve access to healthcare in developing countries. Accordingly, this systematic review of literature was undertaken to identify key approaches from international experiences to enhance access to PHC services in rural communities.

All published and unpublished qualitative and/or mixed method studies conducted to improvement access to PHC services were searched from MEDLINE, Scopus, Web of Science, WHO Global Health Library, and Google Scholar. Articles published other than English language, citations with no abstracts and/or full texts, and duplicate studies were excluded. We included all articles available in different electronic databases regardless of their publication years. We assessed the methodological quality of the included studies using mixed methods appraisal tool (MMAT) version 2018 to minimize the risk of bias. Data were extracted using JBI mixed methods data extraction form. Data were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes.

Our analysis of 110 full-text articles resulted in ten key strategies to improve access to PHC services. Community health programs or community-directed interventions, school-based healthcare services, student-led healthcare services, outreach services or mobile clinics, family health program, empanelment, community health funding schemes, telemedicine, working with traditional healers, working with non-profit private sectors and non-governmental organizations including faith-based organizations are the key strategies identified from international experiences.

This review identified key strategies from international experiences to improve access to PHC services in rural communities. These strategies can play roles in achieving universal health coverage and reducing disparities in health outcomes among rural communities and enabling them to get healthcare when and where they want.

Peer Review reports

Introduction

Universal health coverage (UHC) is used to provide expanding services to eliminate access barriers. Universal health coverage is defined by the world health organization (WHO) as access to key promotional, preventive, curative and rehabilitative health services for all at an affordable rate and ensuring equity in access. The term universal has been described as the State's legal obligation to provide healthcare to all its citizens, with particular attention to ensuring that all poor and excluded groups are included [ 1 , 2 , 3 ].

Strengthening primary healthcare (PHC) is the most comprehensive, reliable and productive approach to improving people's physical and mental wellbeing and social well-being, and that PHC is a pillar of a sustainable health system for UHC and health-related sustainable development goals [ 4 , 5 ]. Despite tremendous progress over the last decades, there are still unaddressed health needs of people in all parts of the world [ 6 , 7 ]. Many people, particularly the poor and people living in rural areas and those who are in vulnerable circumstances, face challenges to remain healthy [ 8 ].

Geographical and financial inaccessibility, inadequate funding, inconsistent medication supply and equipment and personnel shortages have left the reach, availability and effect of PHC services in many countries disappointingly limited [ 9 , 10 ]. A recent Astana Declaration recognized those aspects of PHC need to be changed to adapt adequately to current and emerging threats to the healthcare system. This declaration discussed that implementation of a need-based, comprehensive, cost-effective, accessible, efficient and sustainable healthcare system is needed for disadvantaged and rural populations in more local and convenient settings to provide care when and where they want it [ 8 ].

Different innovative approaches have been practiced in different parts of the world to improve access to essential healthcare services in rural communities. Systematically collecting and combining best experiences all over the world is important to suggest effective strategies to improve access to healthcare in developing countries. Accordingly, this systematic review of literature was undertaken to identify key approaches from international experiences to enhance access to PHC services in rural communities. The findings of this systematic literature review can be used by healthcare professionals, researchers and policy makers to improve healthcare service delivery in rural communities.

Methodology

Research question.

What improves access to PHC services in rural communities? We used the PICO (population, issue/intervention, comparison/contrast, and outcome) construct to develop the search question [ 11 ]. The population is rural communities or remote communities in developing countries who have limited access to healthcare services. Moreover, we extended the population to developed countries to capture experiences of both developing and developed countries. The issue/intervention is implementation of different community-based health interventions to access to essential healthcare services. In this systematic review, we focused on PHC health services, mainly essential or basic healthcare services, community or public health services, and health promotion or health education. Primary healthcare is “a health care system that addressed social, economic, and political causes of poor health promotes health though health services at the primary care level enhances health of the community” [ 12 ]. Comparison/contrast is not appropriate for this review. The outcome is improved access to essential healthcare services.

Outcome measures

The outcome of this review is access to PHC services, such as preventive, promotive, curative, rehabilitative, and palliative health services which are affordable, convenient or acceptable, and available to all who need care.

Criteria for considering studies for this review

All published and unpublished qualitative and/or mixed method studies conducted to improve access to PHC services were included. Government and international or national organizations reports were also included. Different organizations whose primary mission is health or promotion of community health were selected. We included articles based on these eligibility criteria: context or scope of studies (access to PHC services), article type (primary studies), and publication language (English). Articles published other than English language, citations with no abstracts and/or full texts, reviews, and duplicate studies were excluded. We included all articles available in different electronic databases regardless of their publication years. We didn’t use time of publication for screening.

Information sources and search strategy

We searched relevant articles from MEDLINE, Scopus, Web of Science, WHO Global Health Library, and Google Scholar to access all forms of evidence. An initial search of MEDLINE was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe articles. We used the aforementioned performance indicators of PHC delivery and the PICO as we described above to choose keywords. A second search using all identified keywords and index terms was undertaken across all included databases. Thirdly, references of all identified articles were searched to get additional studies. The full electronic search strategy for MEDLINE, a major database we used for this review is included as a supplementary file (Additional file 1 : Appendix 1).

Study selection and assessment of methodological quality

Search results from different electronic databases were exported to Endnote reference manager version 7 to remove duplication. Two independent reviewers (ZG and BA) screened out records. An initial screening of titles and abstracts was done based on the PICO criteria and language of publication. Secondary screening of full-text papers was done for studies we included at the initial screening phase. We further investigated and assessed records included in the full-text articles against the inclusion and exclusion criteria. We sat together and discussed the eligibility assessment. The interrater agreement was 90%. We resolved disagreements by consensus for points we had different rating. We used the PRISMA flow diagram to summarize the study selection processes.

Methodological quality of the included studies was assessed using mixed methods appraisal tool (MMAT) version 2018 [ 13 ]. As it is clearly indicated in the user guide of the MMAT tool, it is discouraged to calculate an overall score from the ratings of each criterion. Instead, it is advised to provide a more detailed presentation of the ratings of each criterion to better inform quality of the included studies. The rating of each criterion was, therefore, done as per the detail explanations included in the guideline. Almost all the included full text articles fulfilled the criteria and all the included full text articles were found to be better quality.

Data extraction

We independently extracted data from papers included in the review using JBI mixed methods data extraction form. This form is only used for reviews that follow a convergent integrated approach, i.e. integration of qualitative data and qualitative data [ 14 ]. The data extraction form was piloted on randomly selected papers and modified accordingly. One reviewer extracted the data from the included studies and the second reviewer checked the extracted data. Disagreements were resolved by discussion between the two reviewers. Information was extracted from each included study on: list of authors, year of publication, study area, population of interest, study type, methods, focus of the studies, main findings, authors’ conclusion, and limitations of the study.

Synthesis of findings

The included full-text articles were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes. Themes are strategies mentioned or discussed in the included records to improve access to PHC services. Themes were identified manually by reading the included records again and again. We then synthesized each theme by comparing the discussion and conclusion of the included articles.

Systematic review registration number

The protocol of this review is registered in PROSPERO (the registration number is: CRD42019132592) to avoid unplanned duplication and to enable comparison of reported review methods with what was planned in the protocol. It is available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019132592 .

Schematic of the systematic review and reporting of the search

We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 checklist [ 15 ] for reporting of this systematic review.

Study selection

The search strategy identified 1148 titles and abstracts [914 from PubMed (Table 1 ) and 234 from other sources] as of 10 March 2022. We obtained 900 after we removed duplicated articles. Following assessment by title and abstract, 485 records were excluded because these records did not meet the criteria as mentioned in the method section. Additional 256 records were discarded because the records did not discuss the outcome of interest well and some records were systematic reviews. The full text of the remaining 159 records was examined in more detail. It appeared that 49 studies did not meet the inclusion criteria as described in the method section. One hundred ten records met the inclusion criteria and were included in the systematic review or synthesis (Fig.  1 ).

Study selection flow diagram

Of 900 articles resulting from the search term, 110 (12.2%) met the inclusion criteria. The included full-text articles were published between 1993 and 2021. Ninety-two (83.6%) of the included full-text articles were research articles, 5(4.5%) were technical reports, 3 (2.7%) were perspective, 4 (3.6%) was discussion paper, 3(2.7%) were dissertation or thesis, 2 (1.8%) were commentary, and 1 (0.9) was a book. Thirty-six (33%) and 29 (26%) of the included full-text articles were conducted in Africa and North America, respectively (Fig.  2 ).

Regions where the included full-test articles conducted

Key strategies identified

The analysis of 110 full-text articles resulted in 10 themes. The themes are key strategies to improve access to PHC services in rural communities. The key strategies identified are community health programs or community-directed healthcare interventions, school-based healthcare services, student-led healthcare services, outreach services or mobile clinics, family health program, empanelment, community health funding schemes, telemedicine, promoting the role of traditional medicine, working with non-profit private sectors and non-governmental organizations (NGOs) including faith-based organizations (Table 2 ).

Description of strategies

a. Community health programs or community-directed healthcare interventions

Twenty-four (21.8%) of the full-text articles included in this review discussed that community health programs (CHPs) or community-directed healthcare interventions are best strategies to provide basic health and medical care close to the community to increase access and coverage of essential health services. Community health programs are locally based health promotion, disease prevention, and treatment programs available typically to communities in need and community-directed intervention strategy is an approach in which communities themselves direct the planning and implementation of intervention delivery. Rural communities, especially, in developing countries have no access to healthcare facilities in the near distance and have less chance to receive healthcare from doctors, health officers, nurses or midwives. In response to this critical problems, many countries have been investing heavily in community based primary health care to bring services to rural and remote areas where most of the population lives. Community health programs include construction of health posts or community health centers close to the community and deployment of community health workers (CHWs), such as health extension workers, to reach-out every village, who play a prominent role as the gatekeepers of healthcare in rural communities. Community-directed healthcare intervention is an approach in which communities themselves direct the planning and implementation of healthcare interventions. Community participation remains crucial in the identification of health problems, planning or designing of health interventions and implementation of the interventions, which enhances need-based and demand-driven provision of health services while promoting sustainability and ownership (Additional file 2 : Appendix 2, Table A1).

b. School-based primary healthcare

In this review, 9 of 110 (8.2%) of the included full-text articles pointed out that school-based healthcare services can be effective to improve access to PHC services. School-based health services are health programs that offer health care to children and youth either in a school or on school grounds and usually staffed according to school community needs and resources. School-based health services provide a variety of healthcare services to underserved children, youth and vulnerable populations in a convenient and accessible environment. Access to comprehensive health services via schools leads to improved access to healthcare (Additional file 3 : Appendix 3, Table A2).

c. Student-led healthcare services

In this review, 5 of 110 (4.5%) of the full-text articles discussed that the use of medical and health science students as healthcare service providers can minimize problems related with shortage of health professionals in rural healthcare system and can play appreciable roles to minimize healthcare service access problems in rural communities. Student-led healthcare services are developed through consultation between universities and local health providers and are purposefully designed clinical placements with a focus on clinical educational activities for pre-registration students. Student-led clinics link students, healthcare professionals, community-based organizations, universities, and communities. In this approach, students can gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs (Additional file 4 : Appendix 4, Table A3).

d. Outreach services or mobile clinics

In this systematic literature review, 18 of 110 (16.4%) of the included studies discussed that outreach services or mobile clinics in primary care and rural hospital settings can improve access to PHC services in rural communities. Mobile outreach service is defined as healthcare services provided by a mobile team of trained providers, from a higher-level health facility to a lower-level health facilities or locally available community facilities that are not used for clinical services, such as schools, health posts, or other community structures. Outreach services improve access to specialists and hospital-based services, strengthen connections between specialists and PHC providers, and give the benefits of consultations in primary care settings. Specialist outreach services have the potential to overcome access barriers faced by disadvantaged rural and remote communities. Furthermore, a community-based mobile clinics can be effective in uncovering illness and in directing patients to a healthcare home (Additional file 5 : Appendix 5, Table A4).

e. Family health program

Four (3.6%) of the included full-text articles discussed that family health program (FHP) is highly cost-effective tool for improving access to healthcare services for deprived areas (such as rural communities). Family health program means the program is a program designed to provide primary care as well as the prevention and early treatment of communicable and non-communicable diseases in defined populations by deploying interdisciplinary healthcare teams include physicians, nurses, nurse assistants, and full-time community health agents. It has evolved into a robust approach to providing primary care for defined populations by deploying interdisciplinary healthcare teams. The nucleus of each team includes a physician, a nurse, a nurse assistant, and full-time community health agents. This approach is effective on improving access to healthcare and eliminating health disparities (Additional file 6 : Appendix 6, Table A5).

f. Empanelment

This systematic review of literature identified that empanelment (also known as rostering) is a best strategy to proactively provide coordinated primary healthcare towards achieving universal health coverage. Empanelment is a continuous, iterative set of processes that identify and assign populations to facilities, care teams, or primary care providers who have a responsibility to know their assigned population. It enables health systems to improve health outcomes and to reduce costs. Empanelment establishes a point of care for individuals and simultaneously holds primary healthcare providers and care teams accountable for actively managing care for a specific group of individuals (Additional file 7 : Appendix 7, Table A6).

g. Community health funding schemes

In this systematic review of literature, 11 (10%) of the included articles discussed that community health funding schemes such as community-based health insurance (CBHI) increases access to healthcare services in low-income rural communities. Community-based health insurance schemes are usually voluntary and characterized by community members pooling funds to offset the cost of healthcare. Moreover, this approach is effective to mobilize domestic resources for health at low income levels. For low-income countries, community health financing has modest ability to increase the total amount of funds for healthcare. Properly structured community health financing system can significantly improve efficiency, reduce the cost of healthcare, improve quality and health outcomes, and pool risks. Community-financing schemes could improve preventive services and reduce the incidence of diseases. It could also improve people’s access to healthcare and the quality of services, thus improving their health status. Community health financing could also improve risk pooling and reduce health-induced impoverishment. Community health insurance has potential positive impacts on health and social security (Additional file 8 : Appendix 8, Table A7).

h. Telemedicine

In this review, 13 of 110 (11.8%) articles discussed that telemedicine is one of the solutions for rural subspecialty healthcare delivery. Telemedicine can be defined as the use of technology (computers, video, phone, messaging) by a medical professional to diagnose and treat patients in a remote location. The provision of subspecialty services using telemedicine to a remote and medically underserved population provides improved access to subspecialty care. Telemedicine brings sustainable healthcare to rural populations. Use of information and communication technologies in support of health and health-related fields, including healthcare services, health surveillance, health education, and health research has the potential to greatly improve health service efficiency, expand or scale up treatment delivery to thousands of patients in the rural populations (Additional file 9 : Appendix 9, Table A8).

i. Promoting the role of traditional medicine

Seven (6.4%) of the included articles showed that incorporating traditional healers into public health system addresses healthcare needs of people with limited access to allopathic medicine. Traditional medicine is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. Knowledge about traditional medicine has a catalyzing effect in meeting health sector development objectives. Integrating traditional medicine into national health systems in combination with national policy and regulation for products, practices and providers can enhance access to PHC services in remote populations (Additional file 10 : Appendix 10, Table A9).

j. Working with non-profit private sectors and non-governmental organizations

In this systematic review, 15 of 110 (13.6%) of the included articles revealed that working with non-profit private sectors and NGOs strengthens the healthcare system. Involving the non-profit private sectors, faith-based organizations (FBOs), and NGOs for health system strengthening eventually contributes to create a healthcare system reflecting an increased efficiency, more equity and good governance in health. International and local NGOs have endeavored to fill the gaps in access to healthcare services, research and advocacy. Non-profit private sectors and NGOs have a key role in improving health in low- and middle-income countries. With networks that reach even the most remote communities, many FBOs are well positioned to promote demand and access for healthcare services. Partnership among FBOs is critical in increasing access to healthcare services, and ensuring sustainability by influencing behaviors at the community, family and individual level. Faith-based organizations play an integral role in the healthcare system by increasing health seeking behaviors and delivering supportive services that address common access and cultural barriers (Additional file 11 : Appendix 11, Table A10).

This systematic literature review found that community health programs or community-directed healthcare interventions, school-based healthcare services, student-led healthcare services, outreach services or mobile clinics, family health program, empanelment, community health funding schemes, telehealth, integrative medicine, and working with non-profit private sectors and NGOs are key strategies to improve access to PHC services in rural communities. The identified strategies address the four major pillars of primary healthcare (i.e., community participation, inter-sectoral coordination, appropriate technology, and support mechanism made available) [ 126 ]. Moreover, the identified strategies are effective to improve access to healthcare services to rural communities. Moreover, the identified strategies are effective to solve shortage of manpower and to build knowledge and skill of the local health workforces in rural healthcare system. The ability of a healthcare system to meet health needs of the population depends largely on the knowledge, skills, motivation and deployment of the people responsible for organizing and delivering health services. The results of this review can strengthen the health information system, which are core elements of the healthcare system that ensure community engagement through dissemination and use of timely and reliable health information to rural populations. This review also suggests strategies to narrow down the health disparities among rural populations, which is wide in most Least and Middle Income Countries (LMICs). Healthcare services are usually disproportionately concentrated in major urban areas. As a result, rural communities face growing health disparities, largely attributed to weak policies, inefficiencies, poor leadership, and governance in healthcare system.

This review identified that community health programs or community-directed healthcare interventions address health disparities by ensuring equitable access to health resources in communities where health equity is limited by socioeconomic and geographical factors. Community health programs include identifying and prioritizing public health problems in a specific geographic area; designing and implementing public health interventions (such as establishing community health centers, mobile clinics, and outreach programs); providing services (such as health education, screenings, social support, and counseling), and deploying community health workers to promote healthy behaviors; advocating for improved care for populations at risk; and working with stakeholders to address community healthcare needs [ 16 , 17 , 18 , 127 , 128 , 129 , 130 ]. The community-oriented PHC model which is socially responsive medicine makes a healthcare system more rational, accountable, appropriate, and socially relevant to the public. Consequently, this model serves as a paradigm for reforming healthcare systems. Community-directed interventions can be considered as a realistic means to increase accessibility of interventions at community-level in rural areas [ 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. This approach is best in situations where there are cultural barriers to implement interventions because this strategy is effective to develop ownership in the community. In-service and on-the-job training for community health workers, close supervision and government support, and program evaluation is very important to strengthen the community health program [ 131 , 132 , 133 ].

This review identified that school-based PHC services are effective strategies to improve access to PHC services. School-based health services provide a variety of healthcare services to children, youth and vulnerable populations in a convenient and accessible environment which indirectly improve leadership and governance. Science teachers and home room teachers play important roles to implement this strategy. It impacts on delivering preventive care such as immunizations, managing chronic illnesses and providing reproductive health services for adolescents. Comprehensive health services via schools improve access to healthcare information [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Access to school around the world increased drastically in the last century [ 134 ]. This high schooling rate is a good opportunity to provide healthcare services to school learners in accessible places and to disseminate health messages to families. Prior researches suggest that school-based healthcare services increase access to healthcare by increasing utilization of primary care, prevention services, and health maintenance visits [ 135 , 136 ]. Including science teachers, home room teachers, school principals, students, communities, community health workers, and other interested parties in the school-based healthcare system as main actors or promoters must be considered to sustain the impact. Health and education sectors should work in collaboration with the above-mentioned actors to plan, implement and monitor the progress. School-based healthcare services are preferable in situations when there is high schooling rate and limited access to healthcare institutions. This strategy is also an alternative way in areas where the health seeking behavior of the community is low.

The use of medical and health science students in rural healthcare system was identified as a key strategy to minimize health inequalities in rural communities due to shortages in health workforce and distribution of healthcare resources [ 49 , 50 , 51 , 52 , 53 ]. Student-led health intervention is an alternative approach to provide essential healthcare services to the community where there is shortage of healthcare workers [ 137 , 138 ]. Students will have opportunities to learn professional skills and competencies while they are providing healthcare services to the community. Moreover, benefits for student learning include increased communication, collaboration, and leadership skills [ 53 , 139 ]. Student-led health intervention also enables increased access to services, more time for assessments and treatments, increased depth of health teaching, holistic and integrated healthcare, and free health supports [ 140 , 141 , 142 , 143 ]. However, the use of medical and health science students in the rural healthcare system may have ethical and competency issues. Supporting strategies such as close supervision, preparing clear protocols, and including senior experts in the team should be considered.

This systematic review of literature found that outreach services or mobile clinics can improve access to PHC service delivery in rural populations [ 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. In developing countries, the highest proportion of people lives in rural areas where doctor services are not available. Rural communities travel to major cities to get specialist services. This reflects a desire for closer integration between primary and secondary care. Specialist outreach services or mobile clinics have become one of the effective solution to solve health disparities, to improve access to healthcare services, and to build capacity of local healthcare workforces. This strategy is preferable in situations when there are high loads in tertiary or referral level hospitals and when there is high patient leakage in the referral system [ 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. However, the implementation may not be easy. It needs well established healthcare system and budget. Moreover, the efficiency of care may be lower compared with hospital-based cares and the effect on patients’ health outcomes might be small [ 56 , 57 , 61 ] . Irregular specialist visits in rural areas may not have real impacts unless the services are sustainable with a strong commitment at national and local levels. Outreach activities should be included in health policies with strong leadership, healthcare financing, and private initiatives must be encouraged to maintain the activities over time.

This review revealed that FHP is highly effective tool for improving health for rural communities. The FHP has provided a new, more robust model of primary healthcare services designed to provide accessible, first contact, comprehensive, and whole person care that is coordinated with other healthcare services. It has positive results to improved availability, access to, and use of health services, and improved health indicators, such as reduced infant mortality, improved detection of cases of neglected diseases, and reduced health disparities [ 73 , 144 , 145 , 146 ]. The FHP deploys interdisciplinary healthcare teams. The team includes a physician, a nurse, a nurse assistant, and full-time community health agents. Family health teams are organized geographically. The teams are responsible for delivering public health interventions [ 72 , 74 ]. Family health program is an alternative strategy in rural healthcare system in situations when there are inequities in access to care; when there is high hospitalization rate; when there is low health seeking behavior in the community; and when there is poor case detecting and reporting system. Despite these remarkable achievements, the FHP has some challenges include difficulties in the recruitment and retention of doctors trained appropriately to deliver primary healthcare, large variations in quality of local care, patchy integration of primary care services with existing secondary and tertiary care, and slow adoption of FHP in large population [ 147 ].

In this review, empanelment has been identified as a best strategy to deliver coordinated primary healthcare towards achieving universal health coverage [ 76 , 77 , 78 , 79 ]. The goal of empanelment is provide people-centered healthcare services based on their needs to ensure that every established patient receives optimal care, whether he/she regularly visits healthcare centers. Major activities in this approach include assignment of all patients to a healthcare provider panel; update panel assignments on a regular basis; and use panel data to educate, and track patients [ 79 ]. Empanelment enables healthcare systems to improve patient experiences, reduce costs, and improve health outcomes. Empanelment is an effective strategy to deliver four key functions: first-contact accessibility, continuity, comprehensiveness, and coordination [ 148 ]. Effective empanelment requires responsibility for the health of a target population, including providing healthcare services based on their health status, which is an important step in moving towards people-centered integrated healthcare [ 79 ].

This review identified that community health funding schemes such as community-based health insurance (CBHI) increases access to healthcare in low-income rural communities. Moreover, this approach is effective to mobilize domestic resources for health at low income levels [ 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ]. Community-based health insurance is an emerging strategy to provide financial protection against the cost of illness. It is an effective strategy to improve access to quality health services for low-income rural households [ 149 ]. Existence of social capital in the community is a determinant factor for the effectiveness of CBHI as social capital has a positive effect on the community's demand for insurance [ 150 , 151 ]. Moreover, solidarity and trust between the members are the key principles for the good functioning of a CBHI. Solidarity and trust stir-up members who are susceptible to risk to put together their resources for common use [ 149 , 152 , 153 ]. Affordability of premiums or contributions, technical arrangements made by the scheme management, timing of collecting the contributions, trust in the integrity and competence of the managers of the CBHI, The quality of care offered through the CBHI, accessible across different population groups are some of the determinant factors to be considered to increase people’s decision to join the CBHI schemes [ 154 , 155 ].

In this review, telemedicine has been identified as one of the many possible solutions for rural subspecialty healthcare delivery. Telemedicine is a vital technological tool to increase healthcare access, improve care delivery systems, engage in culturally competent outreach, health workforce development, and health information system [ 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 ]. Telemedicine can be a great alternative to the traditional healthcare system in situations like diagnoses of common medical problems; inquiries about various medical issues for home treatments; post-treatment check-ins or follow-up for chronic care; holidays, weekends, late night or any other situation when regular medical care is not possible; patient inability to leave the house; patients who lack regular access to relevant medical expertise in their geographic area ; and etc. However, technological issues are challenges when dealing with telemedicine, especially in developing countries. General problems of Internet connectivity and access to infrastructure can minimize benefits of this strategy. Costs associated with technology can also be a barrier. Furthermore, health technology requires human capacity to use it. Therefore, strengthening the information communication technologies (ICT) and human capacity building on ICT are important to address the health needs of the rural communities.

This systematic review of literature identified that promoting the role of TM solves problems of access to allopathic medicine. Integration of TM in health system will result in increased coverage and access to healthcare services. The role of complementary and alternative medicine for health is undisputed particularly in light of its role in health promotion and well-being. It also supports local health workforces [ 104 , 105 , 106 , 107 , 108 , 109 ]. Incorporating traditional healers into the public health system addresses healthcare needs [ 156 , 157 ]. However, integrating TM to the public healthcare system is challenging. It is a general belief that TM defies scientific procedures in terms of objectivity, measurement, codification and classification [ 157 ]. If integrated, who provides training to medical doctors on the ontology, epistemology and the efficacies of TM in modern medicine [ 157 ]. Due to these, some scholars suggest that both TM and modern medicine be allowed to operate and develop independent of one another [ 158 , 159 ]. Another fundamental challenge to TM is the widespread reported cases of fake healers and healings [ 157 ]. Generally, this strategy is more of feasible in areas where formal trainings on integrative medicine are available. Even though the integration is challenging, the health sector can use traditional healers as health educators or health promoters by providing training and continuous support. It can be also possible to use traditional healers as facilitators in the community-directed approaches. In general TM can be used in the primary healthcare system where no access to allopathic medicine and when conventional medicine is ineffective in treatment of disease [ 160 ].

Working with non-profit private sectors and NGOs has been identified as effective strategies to strengthen the healthcare system in developing countries [ 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 ]. Since governments in developing countries are challenged to meet the health needs of their populations because of financial constraints, limited human resources, and weak health infrastructure; the private sector (especially the non-profit private sectors) and non-governmental organizations can help expand access to healthcare services through its resources, expertise, and infrastructure. However, the presence of an NGO in the operation, may contribute to unrealistic expectations of health services, affecting perceptions of the latter negatively [ 113 ]. Moreover, reports have it that besides other issues in many instances NGOs allocated funds only to disease specific projects (vertical programming) rather than to broad based investments (horizontal programming) [ 161 ]. There are also concerns that donor expenditures in developing countries are not only unsustainable but may be considered as inadequate considering the enormous healthcare burden [ 161 , 162 , 163 , 164 ]. To avoid unrealistic expectations and dissatisfaction, and to increase and sustain the population’s trust in the organization, NGOs should operate in a manner that is as integrated as possible within the existing structure and should work close to the population it serves, with services anchored in the community. Moreover, faith-based organizations contribute in health such as disease prevention, health education or promotion, and community health development beyond psychological and spiritual care [ 119 , 120 , 121 , 122 , 123 , 124 ]. Religious organizations can reach all segments of rural populations. Therefore, integrating PHC services, especially health education and promotion, diseases prevention and community health development with religious organizations intensifies delivery of healthcare services. Working with FBOs is a best way in situations where cultural and faith-based barriers are common and in areas, where access problems are often related to lack of providers. However, religious organizations need intensive training on health promotion and health system to enable them to respond to local contexts within the framework of national policies. Moreover, there should be strong partnership with government agenesis to sustain the effort [ 165 , 166 , 167 , 168 ].

Contribution of this review

Various studies reported one or more strategies to improve access to primary healthcare services. However, the strategies reported by individual studies are not compiled together and there is lack of pooled evidence on effective strategies to improve access to healthcare system. This systematic literature review was, therefore, conducted to compile effective strategies to improve access to healthcare services in rural communities. The review suggests key strategies to improve access to PHC services in rural communities. These suggested strategies are implementable in countries that suffer from shortage of health workers and healthcare financing because all the strategies used locally available opportunities. The local healthcare system needs, therefore, scan the available opportunities in the locality for implementing the suggested strategies and needs to integrate the strategies in the healthcare system to sustain the impacts. Healthcare providers, researchers and policy makers could use the results of this systematic literature review to increase access to healthcare services in hard-to-reach areas. As the strategies are compiled from experiences of different countries (developed and least developed countries), there might be contextual differences like socio-economic, cultural, institutional, and geographical challenges to adopt the identified strategies. Moreover, some of the experiences only come from one or two countries. Therefore, strategy developers and implementers need to consider these contextual challenges or variation during adopting and implementing different strategies.

Strengths and limitations of the study

As a strength, this systematic review explores international (both developed and developing countries) best experiences on primary healthcare service delivery and identified ten key approaches to improve access to PHC services in rural communities. We also searched relevant published or unpublished articles, dissertations or theses, discussion papers, and perspectives from a wide range of sources, such as MEDLINE, Scopus, Web of Science, WHO Global Health Library, and Google Scholar.

As a limitation, we entirely relied on electronic databases to search relevant articles. We didn’t include locally available printed out records. We also applied limits for language. We excluded articles published other than English language. We believed we could get more relevant articles if we had access to records available in prints and if we include articles published other than English language. Furthermore, since the strategies are compiled from experiences of different countries (developed and least developed countries), there might be contextual differences like socio-economic, cultural, institutional and geographical challenges to adopt the identified strategies. There was also limited evidence for some articles, especially reports to rate their methodological quality. Readers should also note that our review might missed some important work in improving access to PHC services and the identified strategies are not the only strategies to improve access to PHC services. There might be other effective strategies which are not included in this review. In addition generalizability might be affected since some of the experiences only come from one or two countries. Moreover, this review focuses on access not quality of care delivered.

This review identified key strategies from international experiences to improve access to PHC services in rural communities. These strategies are effective to improve access to healthcare services in rural or remote communities. They can also play roles in achieving UHC and reducing disparities in health outcomes and increase access to rural communities to get healthcare when and where they want. Therefore, incorporating these key strategies suggested by this review in to the healthcare system is useful to enhance PHC services and to minimize impacts of health disparity in rural communities. However, the identified strategies may not be easy to implement. Increasing number and capacity of human resource for health; strengthening the healthcare financing system; improving medicine and supplies; working in different partners and communities; establishing monitoring and evaluation system; strong and committed leadership; and encouraging private initiatives must be considered to implement and maintain these strategies over time. Moreover, policy makers, program planners and implementers who want to utilize findings of this review should be aware that these are not the only effective strategies to improve access to primary healthcare services.

Availability of data and materials

All the extracted data are included in the manuscript.

Abbreviations

Community-based health insurance

Faith-based organizations

Family health program

Information communication technologies

Mixed methods appraisal tool

Non-governmental organizations

• Primary healthcare

Primary Health Care Performance Initiative

Population, phenomena of interest and context)

Traditional medicine

Universal health coverage

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Acknowledgements

The author would like to thank IPHC- E for funding this review.

This review was funded by International Institute for Primary Health Care- Ethiopia (IPHC- E).

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Supplementary Information

Additional file 1: .

Searchstrategy. MEDLINE (PubMed).

Additional file 2: Appendix 2: Table A1.

Description of full-text articles which discussed community health programs or community-directed interventions as a strategy to improve PHC service delivery in ruralcommunities.

Additional file 3:

Appendix 3: Table A2. Description of full-text articles which discussed school-based healthcareservices as a strategy to improve PHCservice delivery in rural communities.

Additional file 4:

Appendix 4: Table A3. Description of full-text articles which discussed student-led healthcareservices as a strategy to improve PHC service delivery in ruralcommunities.

Additional file 5: Appendix 5: Table A4

. Descriptionof full-text articles which discussed outreach services or mobile clinics as astrategy to improve PHC service delivery in ruralcommunities.

Additional file 6:

  Appendix 6: Table A5. Description of full-text articles which discussed family health program as astrategy to improve PHC service delivery in rural,communities.

Additional file 7:

  Appendix 7: Table A6. Description of full-text articles whichdiscussed empanelment as a strategy to improve PHC service delivery in ruralcommunities.

Additional file 8:

  Appendix 9: Table A8. Description of full-text articles which discussed telemedicine or mobile healthas a strategy to improve PHC service delivery in ruralcommunities.

Additional file 9:

  Appendix 8: Table A7. Description of full-text articles which discussed community health funding schemes as a strategy to improve PHC service delivery in ruralcommunities.

Additional file 10:

  Appendix 10: Table A9. Description of full-text articles which discussed promoting the role of workingwith traditional healers as a strategy toimprove PHC service delivery in rural communities.

Additional file 11:

  Appendix 11: Table A10. Description of full-text articles which discussed working with non-profitprivate sectors and non-governmental organizations as a strategy to improve PHC service delivery in rural communities.

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Gizaw, Z., Astale, T. & Kassie, G.M. What improves access to primary healthcare services in rural communities? A systematic review. BMC Prim. Care 23 , 313 (2022). https://doi.org/10.1186/s12875-022-01919-0

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DOI : https://doi.org/10.1186/s12875-022-01919-0

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