(Re)-Organizing the evolving healthcare market: collaborative governance in bureaucratic contexts.

Abstract

This study investigates the use of ‘collaborative governance’ – a pan-sectoral approach to the permanent shifting of regulatory norms – as a response to evolutionary pressures in markets that are classically bureaucratic. We explore the process by which, and conditions under which, such ‘strong’ governments employ collaborative approaches to governance. Using extensive interviews, documentary data and observations in the market of healthcare , we model five roles of the public actor in the collaborative governance process: 1) inviting and enabling field level, organizational participation; 2) capacity building at market and actor level; 3) framing at market and actor level; 4) structuring; and 5) enabling innovation. By comparing two such contexts, in Ireland and the State of New York, we find that pre-existing government roles in the market impact on the need to adopt a collaborative governance approach with governments that play multiple roles in the market, e.g. supplier in addition to regulator, having greater recourse to collaborative governance models. Whereas collaborative governance approaches have traditionally been examined in situations where actors seek to retrospectively insert public good considerations into heavily marketized contexts, we uncover a reversal of such approaches where collaborative governance is instead used to defend public good considerations where this public good faces marketization dynamics. In doing so we extend the application domain for collaborative governance approaches from weak into strong state governance contexts.