Public- private partnership followed by adoption of outsourcing models is a strategy that can fulfill sustainability and increased quality of services in public sector. According to our information based on the latest literature review, this is the first study dealing with the outsourced services and their associated models in Bushehr health care sector.
Findings revealed that the scope of outsourcing of health services included both clinical and non-clinical services. Although this is still a huge gap between the number of contracted out services and the ones potentially could be outsourced. This finding is of remarkable importance and showing that if managers are familiar with the objectives and functions of outsourcing, it can be more smoothly spread at the organization level and this notion that clinical services are difficult to be outsourced is declined. In this regard, Sadeghi et al. In their study entitled review of models of PPP in provision of hospital services concluded that the scope of partnership dependent on the studied country encompassed both clinical and non-clinical services and for achieving this goal, several models had been used and this strategy had led to positive outcomes for patients and hospitals (Sadeghi et al., 2016).
Barati et al. in their study (Barati et al., 2017) examined outsourced clinical units and concluded that three PPP models including lease, cooperative and managerial had been used and outcomes have been mostly satisfactory.
In another study researchers revealed that a number of clinical services through managerial model had been delegated and this process resulted in improved access and satisfaction(Tourani et al., 2010).
The results of Ferdosi .et al (M Ferdosi et al., 2013) showed that outsourcing had been utilized for purchasing nursing services and staff‘s perceptions have been negative towards it. In another research conducted by Ferdosi .et .al they showed that outsourcing has been used for provision of nursing services in ENT and neurosurgery departments using service purchasing model (Masoud Ferdosi et al., 2013).
studies conducted by Khooban et.al and Tourani et.al. Showed that outsourcing has been successfully undertaken for provision of pharmaceutical services and service purchasing has been the used model (Khooban et al., 2013; Tourani et al., 2010). Outsourcing of clinical and non-clinical services as well as its positive and negative consequences has been studied in several more studies (Barati et al., 2019; Chen, 1999; Hsiao et al., 2009; Kahouei et al., 2016; Karimi et al., 2012; Siganporia et al., 2016). and in some cases, the outsourcing model has been mentioned too (Graham et al., 2019; Jannati et al., 2017; Zhiarfar et al., 2014).
Findings the present study also represent that the dominant model has been service purchasing as 84% of total outsourced services have been finalized using this model. This part of findings is consistent with the results of some studies (Berry et al., 2021; Malovec et al., 2015) .one of the reasons attributed to the high usage of this model is that this model has been using for long time ago and as a result familiarity of managers with the terms and conditions of this type model. Additionally, simplicity in implementation has paved the way for being institutionalized.
From another perspective, obtained results underscore that two models including leases and divesture contract (privatization) have not been yet operationalized which comes to large extent back to the low knowledge of managers and also their conservativeness towards outsourcing. Although legal problems are worth noting (Hayati et al., 2015; Raeissi et al., 2018).
Generally, the conducted researches show that although various models exist to outsource services however, this capacity has not been fully utilized and in most cases one or two models have been considered by policy makers and managers. Low motivation and tendency of managers, lack of complete understanding of outsourcing philosophy, unfamiliarity of managers with common outsourcing models, unsuccessful experiences of outsourcing, lack of eligible private provider and weakness in law and regulation are factors that have hindered outsourcing expansion (Mujasi & Nkosi, 2019; Penton et al., 2020; Shaarbafchizadeh et al., 2020).
Lack of access to the outsourced services annually was a limitation that did not allow us to track the rate of implementation of this policy by years in Bushehr University of Medical Sciences.