خرید خدمات بهداشتی و درمانی توسط بخش دولتی:در مقایسه با خرید بخش خصوصی

Recent research has highlighted the existence of important differences between public and private sector procurement practices. Drawing on established transactional and relational conceptual frameworks, this paper examines whether the differing environments confronting public and private sector organisations affects procurement practices. By focusing solely on occupational health services as an example of a complex business service, the research allows the influence of environmental factors, notably policy drivers, to be considered across both public and private sector settings while service specific factors remain largely constant. Utilising a combination of questionnaires and in-depth interviews the research suggests that policy drivers had a major bearing on procurement practices adopted in the public sector, resulting in a very different pattern of engagement with service providers from that prevailing in the private sector. Specifically whereas private sector organisations utilised a range of approaches, which can broadly be classified as relational in nature, public sector organisations almost exclusively relied on transactional-based approaches. The nature of these services suggests that relational based procurement constitutes the optimal approach to the acquisition of such services. However, for public sector organisations the perceived restrictions imposed by public policy on procurement practices resulted in the adoption of an approach which can be viewed as resulting in sub-optimal outcomes.

The public and private sector purchasing environments are seen to be different. With the transactional and relational paradigms as it conceptual base, this paper seeks to determine whether differing public and private sector environments affects the purchasing of a professional service, namely occupational health services. The nature of a professional service like an occupational health service suggests that due to the characteristics of the service, a relational stance of purchasing is more appropriate. A unique element of this research is in confining the research to one particular service whose characteristics are such that a transactional approach it is argued is completely inappropriate, it will become possible to isolate the purchasing process and keep some factors constant. This in turn will help provide a better understanding of how the environment can affect the manner in which a particular service is purchased. Another contribution of this study is that in the current climate of relational purchasing, the purchasing process was predominantly examined through a transactional framework while keeping an open mind to existence of relationships. To achieve this, a questionnaire survey of a selection of private and public sector organisations were undertaken to get an overview of the process. Subsequently, one public sector buyer–service provider dyad was selected for in-depth analysis to help form an understanding of the purchasing process in public sector organisations.

In the purchasing of an intangible and complex professional service such as occupational health, there is evidence that despite the impact of public sector purchasing environment, some public sector organisations, like their private sector counterparts, adopted a more relational stance in purchasing. Nonetheless, in a context where a transactional approach is arguably unsuitable due to market and service characteristics, the only organisations persisting with an open-tendering transactional approach are public sector organisations. The tendency towards utilising transactional mechanisms to purchase is evident throughout the procurement process from selection to post purchase evaluation. In purchasing occupational health services, the public sector in general incurs the expenditure of extra resources, as demonstrated by the use of administratively costly selection mechanisms like open tenders, larger buying groups and greater use of post purchase monitoring mechanisms. The added value of purchasing through a transactional mechanism is at best questionable in this context. In one specific context with several service and market characteristics kept fixed, the suggestion of more transactional approaches being utilised by public sector organisations implies a lack of flexibility in the management of the procurement process. The findings of this study confirm that the public sector purchasing environment may have resulted in transactional purchasing mechanisms being retained. This may be due to pressure to adhere to ‘one size fits all’ purchasing guidelines or simply a lack of awareness of the flexibility allowed in current purchasing guidelines. Another reason could be that public sectors felt under pressure to be accountable and perceived that transactional open tenders was the main method in which to achieve this aim. Equally, it is suggestive that the complexity of the services to being purchased is not taken into account when determining the appropriate level of, and balance between, competition and co-operation. Conversely, there is indicative evidence that competitive open tendering approaches may not be being utilised in full as is demonstrated by the evident lack of switching. In addition, some public sector organisations have, within the confines of prevailing regulations, taken a relational stance to purchasing by adopting increasingly relational selection mechanisms like recommendation. However, even with the recent repealment of compulsory competitive tendering policies and in a context which was exempted from compulsory competitive tendering under the old policies of the early 1990s, in line with Furlong et al.'s (1994) study, the overall the bias in public sector purchasing behaviour remain towards transactional approaches to procurement. This is in direct contrast to private sector organisations where relational approaches overwhelmingly predominate. The data presented in this paper can only be seen as indicative with further research required to confirm the validity and reliability of these findings. Specifically the size of the questionnaire survey with only twenty public sector organisations replying limited the scope of the statistical analysis undertaken and the generalisability of the findings. The utilisation of a larger sample could result in more statistically significant differences being identified. It is also important to acknowledge that representatives of only one public sector dyad were interviewed. To ensure that the qualitative data presented does not represent the views and behaviours of an atypical public sector purchaser, additional case study dyads would have to be examined to substantiate the validity of the data presented. Equally the data presented relates to one highly specific service context and the development of more definitive conclusions would require data to be generated in respect of a broader range of services. The question that follows is whether the research is repeatable in the context other professional services. It would be plausible to postulate that as professional services as a whole has similar market and service characteristics and are under the same legislative influences, this study should be reproducible with similar results in other professional services. Additionally, the data mirrors that generated in parallel studies of public sector procurement suggesting that the data reported is valid. Whether this argument will hold for services in general needs to be further researched. In line with numerous previous studies on purchasing in the public sector context, this research was conducted in the UK context Conceivably, as legislation was found to be one strong environmental factor, the homogenisation of legislation in the EU would suggest that this study would be equally applicable in the EU region. The question is whether the findings of this study will hold outside the EU region. Finally, this study was conducted just when general purchasing legislation was changing, with compulsory competitive tendering being abandoned in favour of creating value through partnerships. Concurrently, it can be held that this would not have affected the findings of this study significantly, given that professional services are exempt from compulsory competitive tendering. There is a need to repeat this study in the current environment whereby all policies of compulsory competitive tendering for all public sector purchases has been abandoned in favour of relational partnerships for a number of years. In conclusion, reinforcing Sanderson's (1998) views, the data suggests that public sector purchasers require to be reminded of the exceptions which exist to general EU and UK government purchasing guidelines and the current repealment of compulsory competitive tendering practices. Equally there is a need for cultural changes within public sector organisations to empower front-line professionals to exercise professional judgement in the management of the procurement process and relationships with service suppliers more broadly. In this context, staff involved in purchasing should be encouraged to utilise such discretion to adopt the most appropriate procurement mechanism for the particular goods or services being purchased. Central to this discretion is the acknowledgement that the most efficient purchasing mechanism may not necessarily be open competitive tendering. The best evidence of this comes from private sector organisations which have identified that the purchasing of complex services such as occupational health is best undertaken through the adoption of more relational approaches. By utilising this flexibility, public sector organisations will be better placed to achieve best value for money and fulfil their role in serving the public. In short, there is no single mechanism that fits all service procurement situations, and flexibility as well as adaptability is the key to the successful and effective procurement of complex services by public sector organisations.