NAVIGATING CO-PRODUCTION CHALLENGES IN HEALTHCARE PPPs: INSIGHTS FROM MULTIPLE CASE STUDIES

This paper investigates the transformative potential of public-private partnerships (PPPs) in the healthcare sector, using the dual lenses of co-production and collaborative governance. Grounded in the New Public Service paradigm (Denhardt & Denhardt, 2000) and key theories of collaborative governance (Ansell & Gash, 2008; Emerson & Nabatchi, 2015), the study positions PPPs as instruments for fostering more participatory, inclusive, and sustainable models of public service delivery. Within this framework, co-production plays a central role envisioned as a process where public institutions, private entities, and citizens collectively design and deliver services (Loeffler & Loeffler, 2021; Scupola & Mergel, 2022). The study is guided by two core questions: How is co- production implemented in healthcare PPPs? And what are the main stages and challenges involved in the process? Using a qualitative multiple-case study methodology (Stake, 2013), the research analyzes two healthcare PPPs through semi-structured interviews and secondary data (Saldaña, 2021; Gioia et al., 2013). The findings point to diverse governance models and a relatively advanced level of co-production maturity despite the presence of notable obstacles. The results suggest that effective co-production within PPPs leads to more patient-centered care and enhances service quality. It also encourages broader stakeholder participation, moving away from traditional hierarchical roles toward shared decision-making and more responsive service design.