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The purpose of this paper is to contextualize the concepts of “service co-production” and “value co-creation” to health care services, challenging the traditional bio-medical model which focusses on illness treatment and neglects the role played by patients in the provision of care.

For this purpose, the author conducted a systematic review, which paved the way for the identification of the concept of “health care co-production” and allowed to discuss its effects and implications. Starting from a database of 254 records, 65 papers have been included in systematic review and informed the development of this paper.

Co-production of health care services implies the establishment of co-creating partnerships between health care professionals and patients, which are aimed at mobilizing the dormant resources of the latter. However, several barriers prevent the full implementation of health care co-production, nurturing the application of the traditional bio-medical model.

Co-production of health care is difficult to realize, due to both health care professionals’ hostility and patients unwillingness to be involved in the provision of care. Nonetheless, the scientific literature is consistent in claiming that co-production of care paves the way for increased health outcomes, enhanced patient satisfaction, better service innovation, and cost savings. The establishment of multi-disciplinary health care teams, the improvement of patient-provider communication, and the enhancement of the use of ICTs for the purpose of value co-creation are crucial ingredients in the recipe for increased patient engagement.

To the knowledge of the author, this is the first paper aimed at systematizing the scientific literature in the field of health care co-production. The originality of this paper stems from its twofold relevance: on the one hand, it emphasizes the pros and the cons of health care co-production and, on the other hand, it provides with insightful directions to deal with the engagement of patients in value co-creation.

The purpose of this paper is to investigate different types of patient involvement in Denmark, and to discuss the potential implications of pursuing several strategies for patient involvement simultaneously.

The paper presents a preliminary framework for analysis of patient involvement in health care. This framework is used to analyze key governance features of patient involvement in Denmark based on previous research papers and reports describing patient involvement in Danish health care.

Patient involvement is important in Denmark at the rhetorical level, and many policies and initiatives have been introduced. All three governance forms (voice, choice and co-production) are used. However, there are important barriers and limitations in translating the rhetoric into practice, and potential synergy and negative synergy effects can be identified when pursuing the strategies at the same time.

Because of the chosen research approach, the research results may lack generalizability. Therefore, researchers are encouraged to test the proposed framework further.

The paper includes implications for the development of patient involvement in health care.

This paper fulfills a need to study different types of patient involvement and to develop a theoretical framework for characterizing and analyzing such involvement strategies.

The purpose of this paper is to compare user involvement in the case of assisted reproductive technologies in England and Portugal through the concepts of voice, choice and co-production, assessing the implications for user empowerment.

This qualitative study draws primarily on policy review and uses exploratory semi-structured interviews with key informants as a way of illustrating points. Data on the following themes was compared: voice (users’ representativeness on licensing bodies and channels of communication between users and doctors); choice (funding and accessibility criteria; choice of fertility centres, doctors and level of care); and co-production (criteria through which users actively engage with health professionals in planning the treatment).

Inter- and intra-healthcare systems variations between the two countries on choice and co-production were identified. Differences between funding and accessibility, regions, public and private sectors and attitudes towards doctor-patient relationship (paternalistic/partnership) were the key issues. Although consumer choice and indicators of co-production are evident in treatment pathways in both countries, user empowerment is not. This is limited by inequalities in accessibility criteria, dependence on doctors’ individual perspectives and lack of genuine and formal hearing of citizens’ voice.

Enhancing users’ involvement claims for individual and organizational cultures reflecting user-centred values. Effective ways to incorporate users’ knowledge in shared decision making and co-design are needed to empower patients and to improve the delivery of care.

The purpose of this paper is to report on current developments in user involvement in healthcare in Slovenia and to explore the issue from the macro-, mezzo- and micro-levels.

User involvement is first contextualised within history of the organisation of healthcare system, from its socialist past through to its post-transitional developments. Second, user involvement is tracked through an analysis of healthcare policies and legislation as well as at its institutional and organisational levels. Finally, user involvement practices are illustrated from the perspective of individual patients. A descriptive and exploratory case study design was employed, including a literature review, document analysis and qualitative thematic analysis of nine in-depth and four semi-structured interviews.

The findings reveal a complex and at times ambivalent picture in which user involvement is still not firmly embedded into the healthcare system, despite being generally accepted.

No systematic qualitative research of patient involvement in Slovenia has previously been published. This research will establish a basis for further investigations of the topic.

The purpose of this paper is to provide and explain the model that underlies most of the research reported within this special issue on “Patient involvement in health care across Europe”.

This introduction provides a literature review and a conceptual framework for the understanding of patient involvement and its potential development within health care across Europe.

Patient involvement can be characterised in terms of three ideal types: voice, choice and co-production. Policies for developing user involvement in healthcare can have disempowering as well as empowering consequences. The pattern of dissemination of user involvement across Europe varies in form and content largely due to path dependency.

The paper provides a template for future comparative research on user involvement in health care and one that could be extended to social care as well as other varieties of human services. This introduction and the special issue highlights the need for further comparative research in this area.

The paper presents a robust model for comparative research. The findings may well be useful not only to researchers but also to policy makers and analysts.

The purpose of the paper is to show the importance of considering patients’ and citizens’ associations for understanding users’ involvement in health care systems.

The paper is based on both qualitative and quantitative data on Italy drawn from various sources (national statistics, own survey data, qualitative interviews).

Although the paper avoids an excessively positive view of the success and frequency of collective patients’ participation, it nevertheless shows that the Italian National Health Care System (NHS) is undergoing important changes in this regard. Voice and co-production among patients, health care services and professionals have become more common and important also because of forms of collective action. Professionals themselves often belong to or promote such associations and groups. The Italian case also shows that voice and co-production tend frequently to merge into a single complex strategy where patients’ requests go along with their direct involvement in health care provision.

The study provides useful information for policy makers considering the implementation of policies that promote collective action in order to increase an active users’ participation in health care.

This is one of the limited number of Italian studies which investigates users’ involvement in the NHS and collective action, thus adding knowledge to the limited research in this field.

The aim of this work is to provide an initial picture of how some design agencies are contributing toward a paradigm shift and how they are developing in the future to better inform design policies and interdisciplinary work. There is a general agreement that the current government and public sector structure and modes of operation need radical transformation. In this scenario, a shift from New Public Management towards New Public Governance paradigm has been auspicated. Design has attracted attention as a potential approach to support this transformation, but research into Service Design, as well as discussions on its future development, for public sector innovation is limited. This paper is an exploratory study into the individual work of seven representative UK design agencies operating for and within the public sector.

The paper reviews literature on public sector reform and innovation to inform comparative studies of contemporary design agencies working for public sector reform. Interviews with seven designers from NHS Institute for Innovation and Improvement, Participle, Innovation Unit, Uscreates, Collaborative Change, Futuregov and Snook are conducted to review their perceived role for public sector reform, their design approaches, exemplar projects and main challenges.

Emerging design strategies for Public Sector reform are: a collaborative design approach that considers all stakeholders as equal co-creators of public value; operating at different complementary levels to aim at systemic change; designing from the inside out (innovation culture) and outside in (market change). These different strategies imply the development of possible different business models. Existing creative tensions appear between embedding and outsourcing strategies, acting as facilitators vs designers, developing both designing and service delivery roles.

This paper is based on a limited sample of design agencies, and it is not a systematic study into the impact of their design work, which should be the object of a following study.

This paper brings Service Design practice into public sector innovation debate to inform future interdisciplinary research and innovation policies. It positions existing design innovation strategies within the wider picture of public sector reform to support a more informed design practice.

Few studies have looked at the UK design agencies for public sector innovation and discussed their possible future developments. This paper provides an original and holistic description of design for public sector innovation with considerations on how it should be interpreted when developing supporting innovation and design policies.

The purpose of this paper is to highlight the need for proper involvement of people with dementia and carers in policy making and to suggest practical ways to achieve this.

Drawing from personal experience derived from a long career in service development in health and social care, the author outlines the importance of recognising that people with dementia and family carers are experts by experience and the merits of involving people at an early stage.

The best ideas come from involved people. Without the insights gained through the lived experiences of people with dementia and family carers, policy makers and professionals run the risk of developing costly services that do not meet the needs of those who will be using them.

A number of key practical pointers are developed and summarised. Engagement and one-off consultations are not enough. Real involvement has to be part of everyday practice, at all levels. It requires investment to enable people with dementia and carers to have a seat at the table, speak about what matters to them and help professionals develop relevant services that meet their needs.

The author is able to draw on particular insights gained as Programme Lead for Dementia at the Department of Health during the development of the first English National Dementia Strategy and, more recently, experience of developing engagement strategies in various localities. This included supporting people with dementia and family carers before, during and after key events at which they shared their experiences with commissioners and service providers.

The ecosystem view is a fascinating perspective which provides management scholars with innovative conceptual tools to investigate the functioning of complex service systems. The purpose of this paper is to focus on the “mega” level of the education service ecosystem in an attempt to explain the relationships between education attainments and income disparities across Europe.

Data were collected from the European Union Statistics on Income and Living Conditions. Data trends over the time period (2007-2010) were investigated, involving 27 European countries. Unobserved time-invariant heterogeneity was controlled and dynamics over time were investigated. A random effects model was estimated for each country. The semi-log functional form is informed by Mincer’s (1974) human capital models.

Education levels were found to be a predictor of income inequality in all the countries included in this research, i.e. higher education level leads to higher income and vice versa. However, the effect of education attainments on individual earnings was irregular. Eastern European countries, inter alia, revealed a strong relationship between education attainments and individual earnings, whereas Scandinavian countries showed a weak link between education levels and income.

Education has the potential to affect income inequalities in Europe. Policy makers should develop tailored strategies to deal with the consequences of education levels on individual earnings. Both education services’ quality and the interaction between education and moderating socio-demographic variables may influence income inequality in European countries.

This is one of the first attempts to investigate the relationship between education and income inequalities drawing on the service ecosystem perspective. Further conceptual and practical developments are needed to better explain the effects of education attainments on income inequality.

This study’s aim is to investigate whether offering a co-production opportunity as a choice or as the only means of service rendering influences customer value creation and satisfaction. This research incorporates two empirically supported sources of co-created value, relational and economic, and it investigates a new dimension of co-created value, individual value. The study focus supports the need for more empirically based guidance for the management and design of co-creation processes.

A 2 × 2 between-subjects experimental design was utilized to test the choice/no-choice condition. Data were collected through a survey of 214 respondents who were selected on the basis of their familiarity with the context of the experimental scenarios.

The results show that co-production as an option for service rendering has a stronger positive impact on value creation than does the context when co-production is necessary. Choice was found to positively influence relational and economic value. Value creation was found to mediate the choice and satisfaction relationship. Individual value had the strongest relative impact on satisfaction but was not significantly related to choice.

Designers and managers of co-production-enabling processes can enhance customer and organizational outcomes simply by offering customers a choice when considering whether or not to engage in co-production.

This originality of this study lies in the supporting evidence found for the influence of choice on value creation and the empirical corroboration for individual value creation as a source of co-created value. The on-line context of this study in this context is also novel.