Presentation at the conference “Are We in this Together? Innovation Capture and the Role of Public-Private-Partnerships in Providing Health Care Services“ Helsinki, 8 April 2015

1. Presentation at the conference “Are We in this Together? Innovation Capture
and the Role of Public-Private-Partnerships in Providing Health Care Services“
Helsinki, 8 April 2015
Jarmo Vakkuri, Professor
University of Tampere, School of Management
FI-33014 University of Tampere, FINLAND
Tel. +358 50 318 6042, e-mail jarmo.vakkuri@uta.fi
Together we govern? Possibilities and limitations in
public-private health care service provision

2. The ambition of the presentation
• To discuss possibilities and limitations of
public private collaboration in health care by
using current research literature and reflecting
case studies and experiences
• Public private collaboration in health care
– As a hybrid form of governance
– As an ambiguity of strategies of hybrid
organizations, as an ambiguity of how performance
of hybrid organizations should be evaluated and
measured
• Performance metrics problems as a special
focus 2

3. Theoretical approach to public
private collaboration - hybrids
• Understanding public private collaboration –
exploring the ”space in between”
• Impure types, demarcation from the original
species of business firms and public
administration
• Hybrid
– As a governance structure
– As an entity
– As a relationship
3

4. Theoretical approach to public
private collaboration - hybrids
Williamson (1991, 294): “…the hybrid
form of organization is not a loose
amalgam of market and hierarchy but
possesses its own disciplined rationale.”
4

5. Hybrid as governance structures – what are the
most efficient ways to organize social activities?
(Williamson 1999)
• ccc
No special
features
markets
Unprotected hazard
Hybrid contracting
FirmNo
protection
Market
support
Private
Regulation
Special features
Contractual support
Administrative
support
Public
Public agency
5

6. Hybrid as an entity
• Hybrids, such as cooperatives, mutual
companies and public enterprises and non-
profits illustrate entities
– having an ambiguous link to shareholder
ownership
– pursuing different level goals at the same time
– demonstrating their performance in different ways;
financial performance vs. social impacts, health
impacts etc.
• Regulatory problems
6

7. Hybrid as a relationship
• Public-private partnerships, (PPP)
• Long-lasting cooperation between public and
private actors in producing services and
products by sharing risk, cost and resources
(Koppenjan, Enserink 2009)
• Forms: Public leverage, outsourcing,
licencing, joint venture, open strategic
partnership (Schelcher 2005)
• A step further: Any meaningful interaction
between public and private actors 7

8. Hybrid forms of governance –
strategies and performance
8
What do hybrids want
to achieve?
How do hybrids demonstrate
their achievements?

9. The role of performance metrics and
evidence in public private
collaboration
• Alternatives for the modes of service delivery
in health care
• Economic incentives for efficiencies, cost
control and cost-effectiveness,
• Product variation, sources of comparison and
benchmarking
• Political landscape; quantification for certainty
in allocating taxpayers’ resources
9

10. Measuring performance in hybrid contexts
10
(Ijiri 1975;Hodges 2012; Vakkuri 2014)
* Search for certainty in public affairs, and in policy decision
making
* Mix of influences of scientific reasoning and technocrathic
ethos (Porter 2006; 2008)

11. Complications for quantifying
performance in hybrid contexts
• Who is the measurer?
– Power to measure, several measurers
• Measuree
– Defining the level of measurement: business firms, public
organizations and other organizations…the link between
entities and activities
– Defining the object: dimensions of performance in health
care service (e.g. the role of customer approach, health
impacts)
• Measurement system
– Measurement rules reflecting the individual entities, and
”easy to measure” activities
• Measurement results
– Information for cost-effectiveness of the health care system?
11

12. Understanding the space in between
– possibilities and limitations
• ”There is nothing so practical as a good theory”
(Kurt Lewin)…hybrids in health care
– More detailed understanding of hybrid forms of
governance in general
– Institutional variants of hybrid forms of governance in
health care
– Regulatory problems
– Performance measurement problems in hybrid
contexts
12