Coopetition in health care: A multi-level analysis of its individual and organizational determinants

Daan Westra*, Federica Angeli, Martin Carree, Dirk Ruwaard

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Cooperative inter-organizational relations are salient to healthcare delivery. However, they do not match with the pro-competitive healthcare reforms implemented in several countries. Healthcare organizations thus need to balance competition and cooperation in a situation of ‘coopetition’. In this paper we study the individual and organizational determinants of coopetition versus those of cooperation in the price-competitive specialized care sector of the Netherlands. We use shared medical specialists as a proxy of collaboration between healthcare organizations. Based on a sample of 15,431 medical specialists and 371 specialized care organizations from March 2016, one logistic multi-level model is used to predict medical specialists' likelihood to be shared and another to predict their likelihood to be shared to a competitor. We find that different organizations share different specialists to competitors and non-competitors. Cooperation and coopetition are hence distinct organizational strategies in health care. Cooperation manifests through spin-off formation. Coopetition occurs most among organizations in the price-competitive market segment but in alternative geographical markets. Hence, coopetition in health care does not appear to be particularly anti-competitive. However, healthcare organizations seem reluctant to share their most specialized human resources, limiting the knowledge-sharing effects of this type of relation. Therefore, it remains unclear whether coopetition in health care is beneficial to patients.

Original languageEnglish
Pages (from-to)43-51
Number of pages9
JournalSocial science and medicine
Early online date26 May 2017
Publication statusPublished - 1 Aug 2017


  • Coopetition
  • Human resources
  • Inter-organizational cooperation
  • Managed competition
  • The Netherlands

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