Abstract
This paper uses insights from the institutional theory to study the competitiveness of the healthcare clinics in Spain. The environment of the healthcare services is highly institutionalized: professional associations are state agents responsible for the extensive regulation. Recently emerged franchise chains become subject for imitation by creating institutionalized routines from within and increasing competitive pressures for other industry players. While the sector is dominated by the independent doctors, franchise organizations are becoming more popular and show steady growth rates. The franchise business model in healthcare is evolving: while the core activity—provision of a healthcare service—cannot be standardized, as the independent judgment of a healthcare professional is legally protected, franchise chains standardize management of the healthcare clinics to achieve efficiency and economies of scale. The survey of the healthcare professionals in Spain shows how professional associations and franchise chains impact the field and provide empirical support to the hypotheses.
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