The impact of publicness on the performance of professional services: Do private sector organizations perform better?
| Author | Salvador Parrado,Anne-Marie Reynaers,José Rama |
| DOI | http://doi.org/10.1177/0952076720977616 |
| Published date | 01 October 2022 |
| Date | 01 October 2022 |
| Subject Matter | Articles |
The impact of publicness
on the performance
of professional
services: Do private
sector organizations
perform better?
Salvador Parrado
Department of Political Science and Public Administration,
UNED (Spanish Distance Learning University), Madrid, Spain
Anne-Marie Reynaers and Jos
e Rama
Department of Political Science and International Relations,
Autonomous University Madrid (UAM), Madrid, Spain
Abstract
This research assesses the impact of the degree of publicness on hospital performance
in a specific ’mixed market’ of public health. This market is characterized by patient
choice, capitation financing for private hospitals, and funding through ‘soft’ budgets
(public authorities partially cover deficits or appropriate profits) for public hospitals.
Previous studies on ownership (economic theory), market logic (on choice), and wel-
fare orientation (role of professionals) offer inconclusive results as to the differences of
performance among hospitals with different degree of publicness. We contrast statistics
related to several dimensions of efficiency and survey data on different aspects of
patient satisfaction. Logistic regression models demonstrate that a higher degree of
publicness is correlated with a lower degree of perceived quality. However, hospitals
with a varying degree of publicness are similarly efficient. These results indicate that
divergences of performance differ amongst performance dimensions and the theoret-
ical expectations need to consider differently these dimensions. Comparisons of the
Corresponding author:
Salvador Parrado, Department of Political Science and Public Administration, UNED (Spanish Distance
Learning University), c/Obispo Trejo, s/n, 28040 Madrid, Spain.
Email: sparrado@poli.uned.es
Public Policy and Administration
!The Author(s) 2020
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DOI: 10.1177/0952076720977616
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Article
2022, Vol. 37(4) 431–456
432 Public Policy and Administration 37(4)
performance of hospitals with a varying degree of publicness should consider the
broader institutional (i.e. market mix) configuration and the specific constraints of
political authority for all hospitals, and not just single organizations. Finally, profession-
alism may play a role in explaining variations or similarities of performance by levelling
out the differences in the degree of publicness.
Keywords
Efficiency, perceived quality, performance management (PM), publicness
Introduction
The dimensional ‘publicness’ approach (Andrews et al., 2011; Bozeman, 2004; Bozeman
and Bretschneider, 1994; Moulton, 2009) in which all organizations are “considered to
be more or less public depending on the extent to which they are subject to political
authority” (Merritt, 2019: 2) is increasingly used in public management research.
Bozeman’s (1987) influential conceptualization that considers the dimensions of own-
ership, funding and the degree of exposure to government regulation to capture an
organizations degree of publicness has changed over time (Carter, 2016; Merritt, 2019).
The degree of publicness, however conceptualized, is suggested to influence organiza-
tional performance (Andrews et al., 2011; Johansen and Zhu, 2014). Whether a high or
low degree of publicness has a positive or negative effect on organizational performance
is subject to academic debate (Merritt, 2019) and the results of empirical contributions
are mixed (Bjorvatn, 2018; Garattini and Padula, 2019; Moulton, 2009).
Scholars have studied the relation between publicness and performance in,
amongst others, the hospital sector. In this sector, mixed markets with public and
private sector hospitals are increasingly common (Rechel et al., 2018; Siciliani et al.,
2017), and there is limited consensus on the key performance distinction between
public and private clinics (Andersen et al., 2016). Findings on the relation between
publicness and hospital performance are difficult to compare because most studies
define and operationalize both concepts differently. Whereas some focus on the
impact of ownership on efficiency (Andersen and Blegvad, 2006; Bartel and
Harrison, 2005; Herrera et al., 2014; Tiemann et al., 2012), others consider the
relation between efficiency and cost containment (Bel and Esteve, 2020). A compar-
ative assessment of performance that uses both objective and subjective measures
among organizations with different degrees of publicness is missing.
Most empirical studies are conducted in the United States, the United Kingdom
and Germany, that belong respectively to the private insurer, the national health
service, and the private insurance health model (B€
ohm et al., 2013). The national
health service model (regulated and financed by the public sector) has evolved into
‘mixed markets’ in which public funding is compatible with competition between
providers for patients within a purchaser-provider split scheme (Siciliani et al.,
2017) and different funding options for ‘money following choice’.
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