Governments world-wide have attempted to use market mechanisms and privatisation to increase the quality and/or reduce the cost of healthcare. England's Health and Social Care Act 2012 is an attempt to promote privatisation through marketisation in the National Health Service (NHS). While the health policy literature tends to assume that privatisation follows from private-sector entry points, we argue that this is more likely if firms expect to make a profit. This paper examines the link between privatisation and marketisation in England drawing on 32 semi-structured interviews with private-sector and public-sector respondents, campaigners, and other experts conducted 6-10 months after the implementation of the 2012 Act.By generating a theoretical framework on the conditions of profitability we seek a better understanding of the conditions under which marketisation leads to privatisation. We find that significant barriers to profit-making remain after the reforms, including a top-down squeeze on prices, uncertainty in market rules, state dominance of funding and provision, and failures to depoliticise the market. These factors restrict privatesector involvement by frustrating profit-making. Where profits are made they are through reduced unit costs and high volumes by a longstanding incumbent in a particular market segment. This, however, restricts marketisation by reinforcing entry barriers Governments world-wide have attempted to use market mechanisms and privatisation to increase the quality and/or reduce the cost of healthcare. 1 England's Health and Social Care Act 2012 is an attempt to promote privatisation through marketisation in the National Health Service (NHS). While the health policy literature tends to assume that privatisation follows from private-sector entry points, we argue that this is more likely if firms expect to make a profit. This paper examines the link between privatisation and marketisation in England drawing on 32 semi-structured interviews with private-sector and public-sector respondents, campaigners, and other experts conducted 6-10 months after the implementation of the 2012 Act. Suggested Citation Krachler, N., & Greer, I. (2015). When does marketisation lead to privatisation? Profit-making in English healthBy generating a theoretical framework on the conditions of profitability we seek a better understanding of the conditions under which marketisation leads to privatisation. We find that significant barriers to profit-making remain after the reforms, including a top-down squeeze on prices, uncertainty in market rules, state dominance of funding and provision, and failures to depoliticise the market. These factors restrict private-sector involvement by frustrating profit-making. Where profits are made they are through reduced unit costs and high volumes by a longstanding incumbent in a particular market segment. This, however, restricts marketisation by reinforcing entry barriers.

Scholars have intensely debated the conditions under which trade unions can successfully mobilize professionals. We explore an internationally comparative perspective on mobilizing professionals by asking how two nurse unions in the United States and Germany successfully limited management's prerogative over staffing levels. We found that German national institutions had little influence over the bargaining process; instead, factors at the level of organizations and their environment (leadership support, organizational restructuring, coalitionbuilding with supportive stakeholders and framing) enabled mobilization. Based on a power resources perspective, we conclude that unions can mobilize professionals using militancy, even without much support from national institutions.In response to declining densities, trade unions in the Global North have adopted militant tactics such as protests, one-to-one organizing and strikes. In the United States, the United Kingdom and Australia, trade union confederations have since the 1980s created training institutions to promote organizing (Heery 2002). Since the early 2000s, German unions have also adopted organizing in Germany's coordinated, macro-institutional context (Greer 2008;Nachtwey and Wolf 2013). Moreover, Change to Win's European Organising Centre has greatly supported new strategies across Europe, including organizing in hospitals (Givan and Eaton Forthcoming).At the same time, national average densities have continued to decline (Ibsen and Tapia 2017). In the meantime, professionalization processes such as licensing have increased, perhaps indicating that such professionalization

Policymakers now have four decades' experience using marketization to address cost and quality problems in public-sector health services. While much is known about the challenges, it is difficult to draw lessons because there remains no agreed-upon definition of marketization. This article contributes a definition that focuses on the transaction, particularly the effects of funding arrangements on the intensity of competition among providers. Based on prior literature and 106 interviews with practitioners and researchers in five countries, the authors contribute a systematization of 12 concrete market mechanisms enacting three market principles. Furthermore, the authors analyze respondents' perceptions of healthcare marketization's effects on costs and quality. While marketization is a multifaceted, sometimes ambiguous phenomenon requiring further research before definite conclusions can be reached, most statements from our respondents about cost and quality effects were negative. Evidence for Practice• Examining health systems in five countries, we identify 12 different market mechanisms, i.e. concrete procedural changes that stimulate competition among service providers. • While these mechanisms sometimes enable improvements in cost and quality, our respondents identified many more examples of markets driving up costs and compromising quality. • A substantial number of respondents also stated that effects were unclear.• More research is needed to assess the effects of market mechanisms in healthcare, for which the article's conceptualization and findings can serve as a basis."T he market" has become a multi-purpose toolbox to address quality and cost problems in public services. In healthcare, policymakers have allowed commercial organizations to provide services while making the public sector more entrepreneurial. However, the consequences of marketization are uncertain, with much conflicting evidence relating to its effects on service cost and quality.Utilizing 106 qualitative interviews, we conceptualize and empirically evaluate marketization and its effects in health systems. We include the state-dominated National Health Service (NHS) in England, the more privatized French health system, the hybrid systems of Slovenia, Finland, and Greece, and interviews at the European Union level. We identify 12 market mechanisms introduced to promote competition in health systems, grouped under three market principles:• Openness: shifting costs from public to private sources, financializing infrastructure projects, and loosening rules excluding non-traditional providers.

The management of the professions has become increasingly challenging, reflecting the emergence of new work roles in professionalized workplaces. Human Resource Management (HRM) scholars have, however, been slow to study the professions, particularly how the power they derive from ownership interacts with other forms of power. This article explores the use of different forms of power by a profession, general practitioners (GPs), in engaging with a new healthcare role, the physician associate (PA). Despite policy support for the role, we find GPs' employment of the role in primary care is low. This is explained by two GP responses to the introduction of the role: employment denial and subordination. We theorize these responses as deriving from GPs' ownership power, enhancing their managerial and knowledge‐based control over PAs. In doing so, we open‐up a research avenue in the study of workforce management focused on professions' ownership power.

The lack of an efficient support system for people with multiple, long‐term health conditions has increased costs, worsened health outcomes, and prompted policymakers to implement a boundary‐spanning role within healthcare settings. While scholars have demonstrated the benefits of coordination roles and other such high‐performance work practices (HPWPs) in this sector, the actual implementation of these practices is less clear. Based on a comparative case study approach, 153 interviews, and other qualitative data, this article explores frontline managers' HR philosophies and practices (‘frontline HRM relationality’) to explain possible variation in efforts to implement the boundary‐spanning role of care coordinators (CCs). Despite strong policy support for the role, coordination has improved unevenly because of varying degrees of HRM relationality: findings show that higher frontline HRM relationality was associated with lower inter‐occupational professionalization differences and higher boundary‐spanning coordination. The article contributes to a nascent literature on HPWP implementation by theorizing frontline HRM relationality as a continuum that moderates professionalization‐related coordination problems and highlights the importance of frontline HRM relationality for implementing HPWPs in professionalized settings.