International perspectives on backsourcing in health: is it just a merry-go-round?

Outsourcing in health was increasingly used in the 1990s as managerialism was adopted across the Italian and Australian public sectors. Many reasons have been given for outsourcing, such as focusing on core competencies, reducing costs and improving efficiency, reducing risk, and improving the management of labor, to name a few. Notwithstanding this, some health organizations have moved to backsourcing.

This research aimed to contribute to the debate and literature on managerial practices in health care by analyzing the extent of backsourcing in public health in Italy and Australia, the reasons, and expected benefits and criticalities.

To achieve the research objectives, a questionnaire was developed, and after a pilot test, it was mailed out to all Italian and Australian public providers. The questionnaire had 10 questions. Most of the responses were indicated on a 5-point Likert-type scale. Descriptive analysis was performed, such as obtaining mean and standard deviation.

The total response rate was 46% in Italy and 29% in Australia. Results showed that nearly 15% of the Italian and 30% of the Australian health care providers had backsourced. In both countries, a lack of complete satisfaction with outsourcing was reported. When backsourcing did occur in Italy, it was due to more freedom becoming available in hiring personnel, whereas in Australia, it was due to quality issues with outsourcing.

Outsourcing can be considered to be an important tool that health care management may use to reach their objectives, but often, similar objectives are in place for backsourcing. This managerial learning-by-doing process seemed to emerge based on past results rather than a clear understanding of the environment and critical evaluation of criticalities prior to the event.