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The purpose of this paper is to reduce the research gap in private sector participation in the Danish and German health systems, where empirical evidence is still very scarce compared with the impressive accumulation of similar literature in Anglo-Saxon countries.

Based on the findings of two case studies – one Danish and the other, a German hospital – the paper assesses the future potential of different private sector participation strategies in health care.

The assessment is that low-level private sector participation approaches such as outsourcing and concession models remain limited and specialised financing instruments for health care in Denmark and Germany due to legal restrictions and lesser importance being placed on operational financial savings and improved management than on achieving strategic goals. Furthermore, existing approaches do not necessarily prepare the ground for public-private partnerships.

To date, longitudinal studies of private sector participation in health care are almost non-existent for continental Europe, yet critical for the assessment of the outcomes of long-term projects of ten to 40 years' duration. In addition, there is still a need for more international comparisons, especially for studies comparing more than two countries.

Case studies about private sector participation in health care with transnational European or international comparisons are very scarce. The paper, which compares two cases of a Danish and a German hospital, is therefore a contribution to reducing a relevant research gap. To date, private sector participation in the German health system, in particular, has rarely been discussed in international journal publications.

Using the example of capital charging in UK hospitals, this paper shows how new public policy initiatives are justified through forms of persuasion without numbers and can be challenged with empirics. A reading of official and academic texts shows how the official problem definition focuses on poor asset utilisation. Hospital accounts are then reworked to show that, although poor asset utilisation was never a major problem, the introduction of capital charges could disrupt service provision. The conclusion is that the operation of NHS hospitals should be understood in terms of distributive conflict, rather than inefficiency. Through practical demonstration, the authors of this article aim to encourage accounting researchers to use numbers to challenge public policy definitions.

In this study, we are addressing changes in managerial logics after the introduction of New Public Management (NPM)-reforms in two public sectors in Norway, namely the hospital and the university sectors. These sectors were previously dominated by professional and political logic in management, and the focus is on professionals in managerial positions. We are asking: How do professionals in managerial positions across universities and hospitals mediate between previous and newly introduced logics in management after NPM-reforms? We have chosen to compare changes in management across the hospital and the university sectors. Both sectors are largely publicly owned and dominated by professions, but their mission differs. The empirical material comprises interviews with formal leaders from dissimilar professional backgrounds, at different levels in the organisations in two cases. The findings show that management influenced by the market logic has been introduced, but in a hybrid version. The professional logic has however not been left behind, but expanded and supplied by a neo-bureaucratic logic. Leadership is functioning as a ‘catalyst’ to handle the different logics. The originality of this paper is a comparison of management in health care and higher education related to a model of hybrid management.

The purpose of this paper is to evaluate clinical departments' performance per clinical sector in the context of the Greek public hospital care system.

The sample consisted of 96 internal pathology and surgical clinical departments in 15 hospitals in Greece and their technical efficiency was assessed by the use of data envelopment analysis. The proposed model used the number of nursing staff, medical specialists and department beds, pharmaceutical expenditure and clinical leadership job satisfaction as inputs while the number of hospitalized patients was selected as an output. Clinical leadership job satisfaction was captured by the use of a specialized questionnaire. The methodology applied investigated variations in technical efficiency in the presence or absence of job satisfaction. The model proposed an efficiency improvement through the possible reduction of inputs (input oriented) variable returns to scale.

Processing the results revealed variations in the way clinical leadership job satisfaction affects efficiency assessments per clinical sector. The impact of job satisfaction is verified for the surgical sector and rejected marginally for the pathology sector. Applied methodology results proposed reductions in pharmaceutical expenditure, human resources and available beds. These are indications towards implementing rational economic and human resources management and productive factors development.

This research effort uses job satisfaction as a quantitative variable to assess efficiency, focusing on clinical efficiency per clinical sector. In all efforts to restrain health expenditure, measuring clinical department efficiency is critical for health policy makers.

The purpose of this paper is to investigate patients’ views toward the perceived service quality of public and private healthcare service providers. Determinants of healthcare service quality were compared by carrying out a GAP analysis to equate perceived and expected services and examined differences in the service quality.

The study sample comprises 310 inpatients of public and private healthcare service providers. Self-administered questionnaires were used along a five-point Likert scale and analyzed through the Statistical Package for Social Sciences. GAP analysis was used to observe the difference between expectations and perceived service quality.

A cross-sectional study revealed significant quality gaps between the expected and perceived services of public and private healthcare service providers; conversely patients’ expectations are not fully met in both types of hospitals. Private hospitals surpassed in terms of overall perceived service quality from their counterparts. Perceived services were found better in terms of physician medical services in public sector hospitals, while rooms and housekeeping services were found better in terms of private sector hospitals.

The result can be used by both public and private healthcare service providers to restructure their quality management practices which could only be possible through effective management commitment, regular patients’ feedback and translucent complaint procedures.

The study conceptualizes the expected and perceived hospital service quality dimensions as an eight-dimensional framework. A comparison between public and private sector hospitals is made to get a better understanding about the differences in the perceived healthcare services among two sectors. Consequences of the study will aid hospital managers and policy makers to get a fuller picture of healthcare services in order to contrive enhancement practices.

Social infrastructure projects such as hospitals are increasingly being procured through public private partnerships (PPP). Due to their complex nature and very high operational requirements, these healthcare projects need special attention in developing robust output specifications at the early procurement stage. The purpose of this paper is to present a model framework of output specifications for adoption by public sector clients in jurisdictions planning to develop hospital PPP/PFI (Private Finance Initiative) projects.

The research is based on an in-depth analysis of best practices from standard and sample project output specification documents used in Australia and the UK for completed hospital projects, reinforced by interviews with key stakeholders in the two countries.

Drafting output specifications for hospital PPP projects is perceived to be a difficult and challenging task due to the complexity and changing needs brought about by evolving health policy, technology and medical advancement. The overarching target of preparing good output specification is to achieve value for money, innovation, risk transfer (including catering for changes), whole life asset performance and establishing performance criteria to link up with the payment mechanism.

The proposed framework is built up from public sector requirements on the physical asset, operational services provided by the private sector, with links to payment mechanism and performance evaluation. It also addresses change mechanism as well as conditions upon hand-over back to the public sector.

Unlike traditional projects which are procured using prescriptive specifications, PPP/PFI projects are procured using performance based output specifications. This paper provides the foundation and a model framework for preparing comprehensive output specifications based on best practices in Australia and the UK, using hospital as the contextual background.

The purpose of this paper is to provide insights into the process of the accounting system change as a part of a larger reform initiative taking place in Norway. The research context is the national network of hospital enterprises.

The paper uses an archival‐based case approach of official documents (between 2000 and 2009) to study the formal layers of accounting practices.

The accrual accounting information signalled major management control problems, but the hospital owner, the state, did not take action to solve these problems during this period. The contracts between the state and hospital enterprises were characterised as principal‐agent relationships. However, different accounting techniques were mixed in the contracts between the parties, indicating hybridisation of accounting systems.

The authors did not study the perceptions and practices of key actors and this is a limitation of the study.

The findings are likely to be useful for practitioners and researchers to gain knowledge on the implementation of management reforms in public sector service organisations.

This paper contributes to our understanding of the diverse processes within which public sector reforms are taking place. The main contribution is a discussion of the diversity in accounting system changes.

Privatization as a general policy was introduced into Malaysia in the 1980s. Subsequently, selected elements of the public health-care system were privatized. This chapter analyzes the effects of privatization on the health-care system in terms of both intended and unintended consequences. The outflow of experienced specialist doctors from the public sector to the private sector and the emergence of a two-class system of health care in Malaysia have been major unintended consequences of privatization.

This chapter draws on a study conducted in the mid 1990s to compare management differences between three different groups of South African hospitals, in order to understand how these differences might have affected hospital functioning. The groups were public hospitals; contractor hospitals publicly funded but privately managed; and private hospitals owned and run by private companies. Public sector structures made effective management difficult and were highly centralized, with hospital managers enjoying little autonomy. In contrast, contractor and private groups emphasised efficient management and cost containment. These differences appeared to be reflected in cost and quality differences between the groups. The findings suggest that in the context of a country such as South Africa, with a relatively well-developed private sector, there is potential for the government to profit from the management expertise in the private sector by identifying lessons for its own management structures, and by contracting-out service management.

Healthcare provision is costly, and patient expectations are increasing. Lean implemented within healthcare settings is one possible solution for dealing with this issue, with much of the current research in this respect mostly focused on developed countries. The research examines the applicability of lean in the healthcare sector of a developing country, specifically Oman.

Interviews were conducted with 32 individuals representing four public sector hospitals, along with two major hospital suppliers and the Ministry of Health. The readiness of lean thinking was assessed against seven criteria. Data were then analyzed thematically.

The authors found that Oman's healthcare sector is strong on leadership support, understanding value and customer groups, ability to undertake an end-to-end process view and engaging in the required training for lean. Interviewees showed awareness of the challenges, including aligning lean with the strategic agenda of healthcare settings, aligning measurement and reward systems to lean thinking and matching demand and capacity levels. The authors conclude that Oman's healthcare sector is ready for widespread application of lean, and if executed successfully, will generate strong strategic and operational outcomes.

This paper provides evidence of the applicability of lean in a very different context to the one that has been generally reported in the literature. The authors propose that lean thinking can be applied in countries and regions with similar cultural contexts such as the Middle East.