The entrepreneurial state: service exports in healthcare and criminal justice

Abstract

This article analyses an overlooked element of public service marketisation, examining overseas export activity within healthcare and criminal justice. It explores the drivers, strategies, opportunities and risks of such activities, and the differences across policy sector. Focussing on contrasting experiences is an opportunity to understand the complex and differentiated operational and structural environments within which this form of “public entrepreneurialism” is expressed. There is a gap in our understanding of such developments and their promotion within the context of austerity. The paper discusses the implications of the entrepreneurial state for public sector reputation.

The making of a global medical tourism destination: From state-supported privatisation to state entrepreneurialism in healthcare in Turkey

“…In addition to responding to Lunt’s (2017) call for research on medical tourism in countries with publicly funded and organised healthcare systems, this article also corroborates previous case studies that find that governments do not consider state support for medical tourism and commitment to universal health coverage as mutually exclusive objectives. Thailand and Colombia, like Turkey, introduced reforms to achieve universal health coverage while simultaneously aiming at strengthening their place in the global market for medical tourism.…”

“…Although the role of the state in promoting medical tourism started attracting attention in policy sciences in the 2010s (Jarman, 2014; Leng, 2010; McCarthy, 2015; Zehavi and Zer, 2013), it is still understudied, particularly in countries with publicly funded and organised healthcare systems (Lunt, 2017). Jarman (2014) offered a reasoned criticism of the medical tourism literature, presenting the main drivers of medical tourism as exogenous to nation-states and portraying states as ‘imprisoned’ by their global context.…”

“…Another case in point is Colombia, where a substantial improvement in social health insurance coverage (OECD, 2015) was followed by a government-supported promotion of inbound medical tourism (De la Puente-Pacheco, 2018). The UK National Health Service (NHS) also provides an illuminating example of the transformation of public sector providers into medical tourism entrepreneurs (Lunt, 2017), in this case as a way to cope with financial austerity, which affected their services (Lunt et al, 2015). Similarly, Zehavi and Zer (2013) identified a bottom-up version of public entrepreneurialism in Israel, where public service leaders act like entrepreneurs by adopting customer internationalisation as a strategy to compensate for cuts to public financing.…”

Risk Aversion of Public Service Marketization Based on Fuzzy Analytic Hierarchy Process

“…His focus on contrasting experiences is an opportunity to understand the complex and differentiated operational and structural environments in which this form of "public entrepreneurship" is expressed. e accuracy of his method is not high [5]. Gang and Hanwen think the provision of public services should be both universal, that is, independent of the social or economic status of the recipients, and contextual, that is, able to compensate for different local needs and conditions.…”

Risk entrepreneurship and the construction of healthcare deservingness for ‘desirable’, ‘acceptable’ and ‘disposable’ migrants in Malaysia

“…The current biopolitical era has been described by sociologist Nikolas Rose as one primarily concerned with the government of risk, whereby diverse actors 'try to identify, treat, manage or administer those individuals, groups or localities where risk is seen to be high' (Rose 2001, 7) through actuarial and epidemiological management strategies. Relations between many states and their subjects are being reconfigured through the management strategy of a specifically neoliberal 'risk shift' (Turner 2007, 305), individualising and privatising health responsibility while commodifying healthcare goods and services previously understood to be 'public' or subject to special protective regulation (Raghuram, Madge, and Noxolo 2009, 6;Jarman 2014;Lunt 2017). This re-drawing of the parameters of healthcare deservingness is by no means smooth and uncontested.…”