Sosiaali- ja terveyspalvelujen resurssinhallinta julkisten hankintojen ja kansainvälisen rekrytoinnin kautta – Esseitä kilpailutuksista, sopimuksista ja etiikasta

Public social and health care (SHC) are services that impact all citizens throughout their lives but are labour-intensive and require significant public sector resources. In Finland, public health system financing has been discussed widely, with many SHC producers heavily reducing their workforces, and contracting out being discussed from a cost-reduction perspective. This dissertation focusses on publicly procured SHC services and international recruitment of health workers by three essays that collectively examine: How can public organisations more efficiently and ethically manage their SHC resources through procurement and international recruitment? Essay I builds on transaction cost economics (TCE) and focusses on how public SHC services are contracted out, and how different service and market characteristics impact tender design, through semi-structured interviews (N = 16), two behavioural experiments (N = 265 and N = 246) and open-ended qualitative data collected through an experimental survey (N = 295). The study develops multiple propositions on tender design and tests two of them. The results suggest that quality criteria should increase with asset specificity, anticipated investments by service providers and service complexity. The essay contributes to public procurement literature by demonstrating that service and market characteristics not only are important in make or buy decisions but also should be considered in how to buy. Essay II explores how (anticipated) ethical consequences and outcomes for different stakeholders impact their prioritisation and discounting of some stakeholders’ needs in international recruitment of health workers. Thirty semi-structured interviews with employers, recruitment service providers (RSPs) and government representatives were conducted and analysed using the Gioia methodology. The study provides several recommendations for managers on how to consider ethical issues in international recruitment. Recommendations for public policy are provided to reduce individual organisations’ burden in ethical decision-making and to ensure that various stakeholders would benefit from international recruitment. Essay III combines topics from the first two essays by investigating how public employers (principals) outsource international recruitment of health workers to RSPs (agents), with a particular emphasis on outsourcing ethical responsibilities and the governance mechanisms employed by the principal. Using agency and stakeholder theories, Essay III draws from semi-structured interviews (N = 30) and tender and contract documents from 12 public international recruitment contracts, focussing on ethical implications relating to three stakeholders: source country, recruited workers and service users. The findings indicate that current governance mechanisms employed by principals are not sufficient to manage all ethical risks related to international recruitment. Based on the documents, governance mechanisms are not well-defined, and some monitoring is fully outsourced to agents, which reduces the principal’s control and visibility. This dissertation makes multiple contributions. First, TCE is used to inform procurement managers on how to buy, instead of focussing on when or what to buy. Second, stakeholder theory and ethical discounting lenses are combined to better understand ethical consequences’ temporal nature in recruitment practices. Third, principal agent theory is expanded with a framework on how principals share ethical responsibilities to agents in international recruitment the governance mechanisms used. Procurement managers are given guidance on how to better consider service and market characteristics when purchasing SHC services, and how to mitigate ethical risks when outsourcing international recruitment. Decision-makers in international recruitment also are given recommendations on conducting the process more ethically.