Advancing the business creed? The framing of decisions about public sector managed care

Relatively little research has clarified how executives of for-profit health-care organizations frame their own motivations and behaviour, or how government officials frame their interactions with executives. Because managed care has provided an organizational structure for health services in many countries, we focused our study on executives and government officials who were administering public sector managed care services. Emphasizing theoretically the economic versus non-economic motivations that guide economic behavior, we extended a long-term research project on public sector Medicaid managed care (MMC) in the United States. Our method involved in-depth, structured interviews with chief executive officers of managed care organizations, as well as high-ranking officials of state government. Data analysis involved iterative interpretation of interview data. We found that the rate of profit, which proved relatively low in the MMC program, occupied a limited place in executives' self-described motivations and in state officials' descriptions of corporation-government interactions. Non-economic motivations included a strong orientation toward corporate social responsibility and a creed in which market processes advanced human well-being. Such patterns contradict some of the given wisdom about how corporate executives and government officials construct their reality.