Interrogating Institutional Change: Actors' Attitudes to Competition and Cooperation in Commissioning Health Services in England

Abstract

Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.

The quest for a better performing health system: Public expertise and corporate management recipes in France

“…And although in theory market forces provide a foundation for efficiency improvements, the lack of competition in France (in many rural areas there is only a single provider; specialist hospitals are rare) restricts the ability of market actors to play one provider against another during contract negotiation. Unlike British fundholding physicians who works as brokers or holders of funds, playing one provider against another to extract better contracting terms and NHS managers who were able to internalize market principles and became more apt at navigating the marketplace and at cooperating in the commissioning of health services (Osipovič et al, ), French health care professionals are neither trained nor equipped to compare providers' costs and services and are often unwilling to play that role, preferring routine habits and structured networks over a marketplace of practitioners and care providers. French General Practitioners also lack the data collection and management skills of their British counterparts (Bras, ).…”

Private management and governance styles in a Japanese public hospital: A story of west meets east

“…Inspired by these works and extending this to the domain of policy but building on previous studies in health governance literature (Osipovič et al, 2016), we believe CPE as a methodological approach would be useful to provide a point of departure for an analysis of health care reforms in Modern Japan. This approach considers the cultural turn (meaningmaking) to the analysis of the articulation between the economic and the political and their embedding in broader sets of social relations (p. 336, Jessop, 2010).…”

“…However, how do the healthcare professionals such as physicians respond to reforms is not well researched. Such research is important, as NPM reforms spread progressively into the conduct of actors and associated governing structures (Osipovič et al, 2016;Van de Bovenkamp et al, 2014). Any form of healthcare reforms requires, Martinussen and Magnussen (2011) argues, due considerations of key actors' embeddedness in historical, cultural and institutional conditions.…”

Juridification, new constitutionalism and market reforms to the English NHS

“…There are countervailing forces to competition, such as resource constraints, which prevent commissioners from undertaking numerous tenders (Osipovic et al 2016: 834), and the squeeze on prices due to austerity and limited budgets (Krachler and Greer 2015: 216–217). In addition, campaigners have influenced commissioner’s decisions.…”