International patients within the NHS: a case of public sector entrepreneurialism.
Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints.
University of York, Department of Social Policy and Social Work, Heslington, York YO10 5DD, UK. Electronic address: Neil.lunt@york.ac.uk.
Neil
N
Lunt
University of Birmingham, Health Services Management Centre, Birmingham B15 2RT, UK.
Mark
M
Exworthy
London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Keppel Street, London WC1E 7HT, UK.
Johanna
J
Hanefeld
London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Keppel Street, London WC1E 7HT, UK.
Richard D
RD
Smith
D016520:Entrepreneurship / Q000458:organization & administration*; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D057193:Medical Tourism; D015279:Organizational Culture; D057766:Policy; D011057:Politics; D017150:Public Sector / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom
Commodification; International healthcare; International patients; Medical tourism; NHS; Public sector entrepreneurialism; UK