Jane Lethbridge

Understanding multinational companies in public health systems, using a competitive advantage framework

BackgroundThis paper discusses the findings of a study which developed five case studies of five multinational health care companies involved in public health care systems. Strategies were analysed in terms of attitude to marketing, pricing and regulation. The company strategies have been subjected to an analysis using Porters Five Forces, a business strategy framework, which is unusual in health policy studies.MethodsThis paper shows how analysing company strategy using a business tool can contribute to understanding the strategies of global capital in national health systems. It shows how social science methodologies can draw from business methods to explain company strategies.ResultsThe five companies considered in this paper demonstrate that their strategies have many dimensions, which fit into Porters Five Forces of comparative advantage. More importantly the Five Forces can be used to identify factors that influence company entry into public health care systems.ConclusionsThe process of examining the strategic objectives of five health care companies shows that a business tool can help to explain the actions and motives of health care companies towards public health care systems, and so contribute to a better understanding of the strategies of global capital in national health systems. Health service commissioners need to understand this dynamic process, which will evolve as the nature of public health care systems change.

The promotion of investment alliances by the World Bank

This article will examine how World Bank policies that influence national healthcare systems have been facilitated through investment alliances between members of the World Bank Group, specifically the International Finance Corporation (IFC) and the Multilateral Investment Guarantee Agency (MIGA), regional development banks and multinational and national company interests. The data used in this article was gathered from the information and publications available through the websites of the World Bank Group, regional development banks, multinational companies and private equity investors. Some of the loan documents available through the websites of the World Bank Group and regional development banks were consulted. The financial complexity of many of the investments in new healthcare systems provides a challenge for future regulatory systems in healthcare. The involvement of a range of private sector interests in healthcare also poses problems for continued development of health knowledge within publicly funded systems.

Public enterprises in the healthcare sector - a case study of Queen Elizabeth Hospital, Greenwich, England

This article responds to a call for more studies of public enterprises with a case study of a public healthcare enterprise, the Queen Elizabeth Hospital (QEH), in Greenwich, England. The QEH was the first hospital to be placed “in administration” since the NHS was founded in 1948. The QEH is a Private Finance Initiative (PFI) hospital. The impact on the QEH, as a PFI hospital, of changes in legislation and bureaucracy and new arrangements for NHS marketisation are examined. The path to being declared an “unsustainable provider” is outlined, with a critique of the recommendations for the merger of the QEH with another local hospital.

Public Sector ‘Ethos’

The term public sector ‘ethos’ encapsulates the defining characteristics of what working in the public sector actually involves and why it is different from working in the private sector. However, it is also a subjective term that can be interpreted in both positive and negative ways. For many public sector workers, it is what makes their work special and different from working in the private sector. For others, it is what makes the public sector appear bureaucratic, out of touch and unresponsive to service users. This chapter uses the word ‘ethos’ in inverted commas, because it is a contested and nebulous term.