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International patients within the NHS: A case of public sector entrepreneurialism

Author

Listed:
  • Lunt, Neil
  • Exworthy, Mark
  • Hanefeld, Johanna
  • Smith, Richard D.

Abstract

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.

Suggested Citation

  • Lunt, Neil & Exworthy, Mark & Hanefeld, Johanna & Smith, Richard D., 2015. "International patients within the NHS: A case of public sector entrepreneurialism," Social Science & Medicine, Elsevier, vol. 124(C), pages 338-345.
  • Handle: RePEc:eee:socmed:v:124:y:2015:i:c:p:338-345
    DOI: 10.1016/j.socscimed.2014.04.027
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    References listed on IDEAS

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    1. Iris Bohnet & Benedikt Herrmann & Richard Zeckhauser, 2010. "Trust and the Reference Points for Trustworthiness in Gulf and Western Countries," The Quarterly Journal of Economics, Oxford University Press, vol. 125(2), pages 811-828.
    2. Colin Hales, 1999. "Leading Horses to Water? The Impact of Decentralization on Managerial Behaviour," Journal of Management Studies, Wiley Blackwell, vol. 36(6), pages 831-851, November.
    3. French, Martin & Miller, Fiona Alice, 2012. "Leveraging the “living laboratory”: On the emergence of the entrepreneurial hospital," Social Science & Medicine, Elsevier, vol. 75(4), pages 717-724.
    4. Nick Llewellyn & Patricia Lewis & Adrian Woods, 2007. "Public management and the expansion of an entrepreneurial ethos?," Public Management Review, Taylor & Francis Journals, vol. 9(2), pages 253-267, June.
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    Cited by:

    1. Loh, Chung-Ping A., 2015. "Trends and structural shifts in health tourism: Evidence from seasonal time-series data on health-related travel spending by Canada during 1970–2010," Social Science & Medicine, Elsevier, vol. 132(C), pages 173-180.

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