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In the mid 1980s, amidst a massive restructuring of U.S. capital and a retrenchment of the welfare state, little attention has been paid to the ill‐defined “nonprofit” or “voluntary” service sector in the American economy. The Filer Commission on Private Philanthropy and Public Needs characterised it in 1975 in the following way:

To investigate the role of social factors, health status, and psychiatric disorders (DSM-III-R) on mental health services use, we utilized the National Comorbidity Survey (NCS), a nationally representative household survey (1990–1992) of the US (n=5877). Multivariate logistic regression allowed estimation of the adjusted odds ratios and 95% confidence intervals on the likelihood of visiting the health or the specialty mental/addictive service sectors. Significant determinants included: gender, race, household income, work status, and quality of community-level health care resources. Those with greater socioeconomic resources or comorbid psychiatric disorders were more likely to visit the specialty mental health sector.

The voluntary sector has an important role to play in the provision of services for people with mental health needs of lesser severity, thus complementing statutory services, as suggested by recent national policy. This article describes such a service for young homeless people, and discusses the perceptions of key stakeholders of the benefits and challenges of such a service. The service largely met the mental health needs of young people who would not have easily accessed statutory mental health services, and who fulfilled the criteria (low/moderate need) of the service. Challenges for the future included the different organisational cultures, the professional isolation of the mental health practitioners and the lack of operational and commissioning links with statutory mental health services.

In Hungary, as in other Central and Eastern European countries, the concept of social enterprise (SE) has attracted increased attention in recent years, with certain key actors shaping the organisational field. This growing interest is largely because of the availability of European Union funds focussing on the work integration of disadvantaged groups but ignoring other possible roles of SEs. This study aims to consider a seldom examined and underfunded area: SEs’ institutional environment and organisational activities in the social and health sectors.

Based on neoinstitutional theory, the paper uses desk research and qualitative case studies. It presents the experiences of SEs providing social and health services for specific disadvantaged groups.

This paper identified the key actors influencing the everyday operation of SEs and examined their connections, interactions and partnerships. Based on the findings, SEs primarily depend on the central state, public social and health institutions and local governments. At the same time, their connections with private customers, networks, development and support organisations, third sector organisations and for-profit enterprises are less significant. The key actors have a relevant impact on the legal form, main activities and the financial and human resources of SEs. SEs, however, have little influence on their institutional environment.

The paper contributes to understanding the opportunities and barriers of SEs in Hungary and, more generally, in Central and Eastern Europe, especially regarding their place in social and health services.

The purpose of this paper is to present a historical overview of the health service sector in India. The development in the healthcare sector from the late eighteenth century into current times is examined from the prism of the role played by British and US healthcare systems in influencing change in the Indian setup.

Online databases searched were PubMed and JSTOR, using the search terms, “Indian health service system in transition”, “British influence on the Indian healthcare setup” and “American neo-liberal influence on Indian healthcare sector”. The authors then examined titles and abstracts of selected articles for short-listing relevant articles. Reference lists of selected articles were examined for further locating related studies. While this constituted the secondary literature for the current paper, reports by governmental and non-governmental organisation reports on the Indian health service system too were utilised as primary data sources.

Influenced by the British and later by the American healthcare system, the Indian healthcare network has undergone numerous changes. In the present era, the Indian healthcare system is increasingly veering towards the American model of healthcare delivery. Health is increasingly being conceived of as a commodity to be traded in the market, with the state’s role curtailed towards provisioning for and facilitating access of the weakest sections of the society through a means-tested insurance system. This has happened without adequate checks and balances on the private sector to ensure that the needs of the people accessing the system are adequately met.

By tracing the development of the health service sector in India and the motives that guide such change, the paper depicts how the thrust of the system has altered from one providing universal healthcare services to the people, irrespective of their ability to pay, at the time of independence to commercialisation in present times. With the marketisation of healthcare, the focus has shifted from serving people to profiting from the provisioning of healthcare.

The paper throws light on the underlying inadequacies of the Indian healthcare setup and the need for more active participation by the government in this sector in the future if it aims to make healthcare more equitably accessible to its vast population.

This paper aims to provide insights into how the New Zealand Office of the Auditor-General (NZOAG) legitimised the selection of topics for performance audit in the New Zealand public health sector over a 10-year period, 2003-2013, by fulfilling the key actors’ “taken for granted beliefs” of the dual roles of the NZOAG: its independence and accountability.

This paper uses evidence gathered from interviews with representatives of the District Health Boards, the Ministry of Health (including Health Advisory Committee members) and NZOAG staff, along with publically available documentary evidence over a 10-year period. The authors draw on Suchman’s (1995) authority on institutional legitimacy to inform the research findings.

The New Zealand Auditors-General (NZAGs) get inputs from various sources such as their own audit teams, parliamentary deliberations, the Ministry of Health, the District Health Boards, media and public concerns and complaints. These sources initiate ideas for performance audits. Subsequently, the NZAGs use the recurring themes and risk assessment criteria while simultaneously consulting with the auditees (the MOH and the DHBs) and other actors, such as health advisory groups, to select topics for such audits. This signals to the key actors, such as the MOH and the DHBs, that the NZOAG is addressing the topics and concerns relevant to the former while discharging its public accountability role. Furthermore, the consultative approach acts as a catalyst, ensuring that the actors involved with public sector health service delivery, specifically the auditees, accept the selected topic. This leads to a lack of resistance to and criticism of the topic; the selection process, therefore, is legitimatised, and credibility is added to the audits. Because of the consultative approach taken by the NZAGs, the actors, including the performance auditors, continue to believe that the Office acts independently from third party influence in selecting their audit topics, elevating the NZAGs’ moral legitimacy with respect to their public accountability role.

The study’s focus group does not include parliamentary representatives, only representatives from the DHBs, the MOH and the NZOAG; therefore, the conclusions on effective discharge of the NZOAG’s accountability role and Parliamentary acceptance is not conclusive – the NZOAG acts on behalf of the Parliament in discharging its accountability role and the latter is also the formal recipient of the reports.

The implications for practitioners and policymakers are that the use of a consultative approach to select topics for performance audit in the absence of performance auditing standards ensures auditee readiness and acceptance of such audits. This also promotes mutual benefits and “trust” between the AG and auditees. Such audits can be used to bring about efficacy in health service delivery.

The selected topics for audits will have an impact on citizens’ lifestyles, with improved health services delivery.

There is a dearth of research on who initiates the ideas for performance auditing and how the Office of the Auditor-General selects topics for such audits. This study adds a new dimension to the existing performance auditing literature. The authors reveal how the NZOAG seeks to legitimise the selection of topics for such audits by consulting with the auditees and other actors associated with public sector health service delivery, while upholding its independent status and making transparent how it discharges its accountability role within the context of performance auditing.

As entrepreneurship and market mechanisms are increasingly seen as a central part of public sector reforms to health and education, this chapter examines the entrepreneurial behaviour of public service providers in rural areas of the United Kingdom. Specific questions to be addressed include: How do rural providers (GPs, hospitals, schools) respond to the ‘market’ for provision of public services in rural areas? What are the constraints in acting entrepreneurially in these rural ‘markets’?

This chapter draws on a review of the literature and an empirical study of health care providers and schools with an emphasis on provision in rural areas and non-metropolitan urban areas. The results are based on 130 interviews with public, private and not-for-profit sector providers, and commissioners in health and education. Providers interviewed include schools, primary health care providers (General practitioners) and hospitals.

The challenges facing rural provision are examined. In terms of income generation providers reported the difficulties in having the critical mass required to keep services viable. There was particular attention to finding ways of diversifying income sources to increase turnover. Providers for rural areas are also having to find ways of coping with increased costs compared to urban providers, with limited account taken by the commissioners/buyers of services. The constraints related to introducing entrepreneurial behaviour to individuals who are resistant to risk taking and innovation based on market forces are also examined.

The work is based on a qualitative survey of a number of sectors. Further larger sample work is required to explore the propositions identified in more detail. The policy context has also been changing, with a need to identify how changes in government have affected the nature of entrepreneurship in public services.

The chapter provides policy implications and insights for providers of rural public services. There is a need to encourage diversity of income sources and to encourage collaboration between providers. There is also a need to identify where entrepreneurs in the public, private and social enterprise sectors are unwilling to deliver.

The chapter identifies key theoretical issues related to the role of enterprise in delivering public services. Further insights are provided regarding the role of rurality on both enterprise behaviour and public service delivery.

According to Global Healthcare Security Index 2021, India ranked 66 out of 195 countries, indicating the need and scope for improvement. The Cooperative healthcare system which has been rendering exemplary services is yet to gain visible recognition in India. Given the need for upgrading the health infrastructure in India and providing more affordable health services to the country’s growing population, it would help appreciate the large role that cooperative healthcare can play along with others. This study explores the structure, conduct, and performance of healthcare co-operatives in India, the factors contributing to their success and failure, and the challenges they face. The Health Cooperatives have a strong presence in Kerala and Karnataka and are also coming up in other parts of the country. However, a detailed database of them for public awareness is very limited. The cooperative hospitals can meet the basic requirements of curative treatment in rural and poorly-endowed urban areas. The democratic way in which they function makes them a destination for a financially weaker section. They must retain this feature. The study covers two successful cases which reveal that India needs a more dense healthcare cooperative network. Since cooperative hospitals in tune with the spirit of service run on the principle of being ‘Not-for-Profit’ they need to be supported by the governments more liberally, without however interfering with their governance and administration.

The purpose of this study is to provide current state of knowledge on how the COVID-19 emergency situation necessitated the behaviour influencing use and acceptance of telehealth. This study interlinks the health belief model (HBM) and the unified theory of acceptance and use of technology (UTAUT) to highlight the challenges and opportunities as a result of the COVID-19 pandemic in the public health sector.

This study used three online databases (Emerald publishing, Science Direct and Taylor and Francis) that enabled the authors to access electronic journal articles. Search strategy was used to extract articles based on the relevance of this study.

The key findings from this study suggested that the COVID-19 emergency forced health-care workers and their patients to rapidly use and rely on telehealth to reduce the rate of COVID-19 transmissions. The key benefits of telehealth use highlighted an expansive cost effective and convenient access to health-care services irrespective of geographical local and levels of physical impairment. Moreover, telehealth inhibited in person human interaction, which was perceived as impersonal and not ideal for new patient consultations. The barriers outweighed the benefits; as a result, it is unlikely that there will be a wide use of telehealth beyond the COVID-19 emergency situation.

The research findings are limited to discussions drawn from available secondary data. The criteria within telehealth for policymakers to note the technology acceptance and use for both health-care and outpatient stakeholders and their health seeking behaviour. Health-care sectors (private and public) and government need to understand enablers of effective telehealth in policymaking to ease the barriers during an emergency situation like a pandemic.

This study contributes to the emerging literature on how COVID-19 pandemic has disrupted and accelerated telehealth by extending both the UTAUT and HBM theories. This study is expected to contribute and expand literature on telehealth during emergency situations, given the novice nature of COVID-19 and limited literature surrounding it.

Despite enormous progress in health globally, primary healthcare services in many developing countries are facing different challenges. Many studies have documented that decentralisation could be useful in supporting and developing health services closer to citizens. The purpose of this paper is to assess the effect of decentralisation on health services, and to draw general lessons which might help to develop appropriate strategies to improve health services in Nepal.

A mixed method was used, consisting of reviews of current literatures relevant to decentralisation and health performance, engaging with health service inputs‐outputs data between 2001 and 2007, and assessing the range of choices (management, finance and governance) available to local authorities using Bossert's “decision‐space approach”.

Decentralisation in many countries, including Nepal, suggests a new form of service delivery.

Review of the selected studies in triangulation with health services data has revealed that decentralisation in many cases has improved access to, utilisation of, and management of health services. The effects on other performance dimensions such as policy, equity, quality and service effectiveness are poorly investigated topics in the literature. The findings suggest that the successful implementation of decentralisation requires a broader context of institutional capacity building and resource management, and underlines the need for their consideration during implementation processes, and further investigation.