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This paper aims to address the crucial interactions that a start-up enacts with actors from the public sphere in a context of medical technologies. The public actor commonly plays multiple roles, ranging from co-developers and financiers to large-scale users, which are all pivotal to the development and survival of the new venture. The paper investigates the possible “dark sides” of a start-up’s marriage with a public partner, departing from three specific roles the public sphere can assume in relation to a start-up: as a development partner, as a financer and as a customer.

The study builds on an in-depth empirical case study of a Swedish med-tech startup company.

The authors find the financing role to be least problematic, whereas the customer role is the most problematic in that it provides numerous barriers to the possible development and growth of a start-up firm striving to get new customers in a public setting. Examples of the most prominent barriers found are regulations, complex decision-making processes and assessment elements of med-tech products that are outside the control of the startup firm, hence issues that cannot be handled within inter-organizational relationships.

The study builds on 27 in-depth interviews, which were undertaken during 2005-2013, thus contributing detailed data about a start-up’s many and crucial interactions with different public actors. Departing from three different roles, a public partner can adopt in relation to a start-up, (development, co-financer and customer) provides results with managerial implications for start-up’s and policy implications for health-care policy.