The corporatization of healthcare organizations internationally: A scoping review of processes, impacts, and mediators
| Published date | 01 June 2022 |
| Author | Simon Turner,John S. F. Wright |
| Date | 01 June 2022 |
| DOI | http://doi.org/10.1111/padm.12724 |
SYMPOSIUM ARTICLE
The corporatization of healthcare organizations
internationally: A scoping review of processes,
impacts, and mediators
Simon Turner
1
| John S. F. Wright
2
1
School of Management, University of los
Andes, Bogota, Colombia
2
University of Technology Sydney, Institute of
Public Policy and Governance, Sydney, New
South Wales, Australia
Correspondence
Simon Turner, School of Management,
University of los Andes, Bogota, Colombia.
Email: s.turner@uniandes.edu.co
Funding information
“Fondo de Apoyo a Profesores Asistentes”
(FAPA) de la Universidad de los Andes
Abstract
Corporatization, the conversion of state-owned enterprises
into semi-autonomous, legally independent entities, has
gained in popularity internationally since the 1980s. This
review suggests that usage of the term has become
entangled with other definitions of corporatization, and
other organizational reforms associated with new public
management, and appears consequently to have lost its
distinctiveness in many contemporary studies of corporati-
zation. Through a scoping review of literature on corporati-
zation of healthcare organizations internationally, we
develop a typology of four perspectives on corporatization
(as managerialism of medical work, as institutional level
reform to encourage market-like behavior, as corporate
governance implications of legal independence, and as pri-
vate sector colonization) and analyze the specific processes,
impacts, and mediators associated with each approach. This
typology can aid conceptual clarity in future research on
corporatization and orient practitioners to particular
management and policy questions within the complex field
of reform signified by this term.
1|INTRODUCTION
Research on and views about corporatization abound. One view regards corporatization as the conversion of
state-owned enterprises into semi-autonomous, legally independent entities. Another emphasizes the “hybrid”
nature of corporatized organizations in which organizational components from the private sector (e.g., governance
structures, financial autonomy) are combined with continuing public ownership and goals. Others relate
Received: 30 June 2020 Revised: 10 January 2021 Accepted: 27 January 2021
DOI: 10.1111/padm.12724
308 © 2021 John Wiley & Sons Ltd Public Admin. 2022;100:308–323.wileyonlinelibrary.com/journal/padm
corporatization to all manner of public sector reform, often associating the emergence of corporatized forms with
ideas from new public management (NPM) theory. A further strand of literature links corporatization to
“privatization,”whether that be private companies entering public services or the private sector serving as a model
for service organization and delivery. These differing views on corporatization also have consequences for its study.
The study of corporatized organizations as a hybrid form is likely to consider how interactions between their “public”
and “private”aspects shape public service delivery, for example, a governance structure oriented toward promoting
financial performance may neglect democratic influences (e.g., end-users' views). To examine the influence of corpo-
ratization on public service organization, it is necessary to take account of the conceptual moorings of the term to
understand what practices are signified by corporatization and the implications for its study and for public
administration.
This study is contextualized in the healthcare sector which has been influenced by corporatization internation-
ally. One review concludes that evidence on the impact of corporatization on healthcare organizations is mixed and
patchy (Braithwaite et al., 2011). There are a number of reasons for revisiting the literature on corporatization. First,
the searches that informed Braithwaite et al.'s review were conducted in May 2007. Given the implementation of
austerity programs and public sector spending reforms in many OECD states as a result of the 2008 financial crisis
revisiting this literature is timely. Second, it is important to study corporatization as a multilevel process to capture
interactions between the macro policy context and processes at the organizational and professional level. Third, due
to the variety of practices and terminology associated with corporatization—including its relationship with
privatization—mapping not only processes but also impacts associated with the term is critical. A review of the
related concept of “agentification”across European public sectors found that only 7% of studies evaluated outcomes
(Dan, 2014).
The aim of this article is to identify different approaches to the study of corporatization and, using this typology,
to appraise recent literature on processes, impacts, and mediators of healthcare corporatization. In the next section,
different approaches to the study of corporatization are described; section 3outlines the methods used in this
review. Section 4describes the findings by theme which is then followed by the discussion section (section 5) and
conclusion (section 6).
2|APPROACHING CORPORATIZATION
The term “corporatization”lacks a commonly agreed definition. It is possible to discern two main approaches to the
treatment of the term in public administration and related fields. The first approach defines corporatization narrowly
as a change in legal form that give the resulting entity greater independence, while differing from privatization
because public ownership persists (Andrews et al., 2019). An emblematic definition is provided by Lindlbauer et al.
(2016) who state that corporatization involves “a change in legal form that separates service delivery from traditional
government agencies while keeping the organization in public hands”(p. 310). The key characteristics of corporatiza-
tion described here are processes of “separating”and “keeping”which reflect the idea of moving responsibility for
service provision away from state control, while retaining public ownership through stock or shareholding. In
England, National Health Service (NHS) Foundation Trust (FT) hospitals are independent public benefit corporations
with an elected board of governors and membership body (composed of staff and local people), but the state retains
ownership and may provide financial assistance (Allen et al., 2011). As corporatized entities can take a variety of
organizational forms (Kirkpatrick et al., 2016), the legal form perspective does not imply the existence of particular
governance arrangements or other internal characteristics (e.g., the shape that “business-like”behavior might take
following corporatization).
The second approach is an eclectic one that links corporatization to all manner of public sector reform, often
associating these with ideas from NPM theory (Hood, 1991). While this broad approach reflects many recent policy
developments in public service delivery, we suggest that associating myriad “business-like”reforms with
TURNER AND WRIGHT 309
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