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VictorA.Pestoff
whenservicesandworkintheservicessector
havebecomethepredominantformofproduction
andemployment.Ostrom(1996)andOsborne
etal.(2013)underlinethedifferencesbetween
producinggoodsandprovidingservices.Unlike
goods,servicesoftenrequireaninputoractive
contributionfromusersorclientsintheproduction
processitself.Thismakesthemco-producers
ofsuchservices.Personalsocialservicesareoften
considered“relationalgoods”byeconomists.If
theyarelong-termor“enduringwelfareservices”,
dissatisfieduserswilloftenhavefew,ifany,
optionstoexit.Thismakesvoicemoreimportant
forexpressingconsumerdissatisfactionand/
ormakingsuggestionstoimprovetheservice
experience(Pestoff,1998).
HealthcareinEuropeandmanyotherdeveloped
countriesisnowfacingacomplexandpartly
contradictorymixofchallenges.Fiscalstrains
combinedwithaNewPublicManagementagenda
havecausedcutbacksandcallsforimproved
efficiencyinpubliclyfundedhealthcare.This
developmentisasignificantcontributortothe
growingconcernaboutservicequalityinhealthcare.
Otherdevelopments,suchasincreaseddemand
duetoagingpopulationsandanincreasedlevel
ofindividualisationofservices,alsoaddtothe
mix.Theproposedsolutionstothesechallenges
inEuropeanhealthcarehelpillustratetheseverity
oftheproblems.Onesolutionsuggestedbymarket
proponentsistofurtherconcentrateresources
inlargerproductionunitsandincreaseefficiencyin
orderto“providemorecarewithbetterquality”.The
problemwiththissolutionisthattheScandinavian
countriesalreadyhavesomeofthemoststreamlined
healthcaresectorsintheworldandthereisprobably
alimittohow“efficient”youcanmakehealthcare
serviceswhilemaintainingacceptablelevels
ofservicequality.Anotherpossiblesolutionwould
betoincreasepublicfunding,butmostEuropean
countriesalreadyhavethehighesttaxesintheworld.
Thus,giventhesealternatives,akeyissueforfuture
healthcareinEuropeistofindawaytoprovidehigh
qualityservicestoagreaternumberofpatientsat
areasonableandsociallyacceptablecost.
Adifferentkindofsolutionisreflectedinthe
growinginterestinandpracticeofincreasing
publicparticipationinhealthcare.Morethan
adecadeagotheWorldHealthOrganization(WHO)
maintainedthattherewerebasicallythreeways
ormechanismstochannelpublicparticipation
inhealthcaregovernance:“choice”,“voice”and
“representation”.Choicemostlyappliestoindividual
decisionswhenselectinginsuranceproviders
and/orservices.Voicetendstobeexercisedat
thegrouporcollectiveleveltoexpresspublicor
groupviews.Representationimpliesaformal,
regulatedandoftenobligatoryroleintheprocess
ofhealthcaregovernance(2005).IntheUnited
Kingdomitwasrecentlyarguedthatpublicand
patientengagementinhealthcareis“anideawhose
timehascome”(Hudson,2014),whiletheOffice
ofPublicManagementstatesthat“co-production
isthenewparadigmforeffectivehealthand
socialcare”(Alakesonetal.,2013).Moreover,
co-productioncanpotentiallycombinechoice,
voiceandrepresentation,byactivelyengaging
citizensintheprovisionofpublicservices,at
thesiteofservicedelivery(Pestoff,2008and2009).
Peters(1996)statesthatmobilisingandharnes-
singresourcesbeyondthecommandandcontrol
ofleadersinthepublicandprivatesectorsis
becomingincreasingcrucialforthesustainability
ofsocietyandtheachievingofbothpublicand
privategoals.Citizensprovidecriticalresources
today,soweneedtoconsiderhowbesttomobilise
andharnesstheirresources,bothintheirroleas
professionalserviceprovidersanduser/citizen
orco-producersofpublicservices.Moreover,
hearguesthatinordertomobilisevastlatentor
currentlyunusedresourcesinthepublicsector
aparticipatoryadministrationmodelshouldfocus
onempoweringthelowerechelonsoftheservice
providersandtheirclients,whichwoulddecentralise
muchofthedecision-makingtothem.Thisshould
bereflectedintheirworkenvironment,work
satisfactionandhowtheyperformtheirdailytasks.
Giventherelationalnatureofmanyservices,
includinghealthcare,ourstudyispremisedon
theassumptionthatworkenvironmentandservice
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ZarządzaniePubliczne/PublicGovernance1(47)/2019
