Not Reporting a Profit: Constructing a Non-Profit Organisation

Public sector reformers advocate contracting-out as a means of improving cost-effectiveness. In the health sector, market-based contracts with for-profit organisations can reduce equity of access and divert public funds to private gain. Such issues have prompted policy makers to seek alternative contracting strategies. This paper examines a primary health care policy whereby government contracts with private non-profit organisations to increase efficiency and meet World Health Organisation ideals. The study found that the policy's implementation has not achieved these aims when for-profit providers masquerade as non-profit organisations. The implication is that governments may find it more effective to manage for structural diversity than mandate homogenisation.