Commercial determinants and market power in Australian private health services: An analysis of corporate growth in the private health sector
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2026
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Melbourne Authors
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Melbourne School of Public Health (MSPH)
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PhD thesis
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© 2026 Tom Shore
Abstract
Background
Privatisation and corporatisation have become popular strategies used by governments globally to address rising public healthcare costs. In Australia, the State and charitable organisations traditionally took responsibility for hospital care. During the 1980s, the historical ‘cottage industry’ model of private owner-operated hospitals changed as larger corporations entered the healthcare sector leading to increasing consolidation and corporate control. This shift in Australia echoed global trends in healthcare provision. Critics of privatisation raise concerns about whether increased corporate control comes at the expense of public healthcare and health equity. The main research question that animates this study is: How has the private sector grown and consolidated its influence over the delivery of health services in Australia? The thesis begins with the proposition that there is an unresolved and highly vocal contestation over whether companies can maximise both profits and public health outcomes simultaneously. To interrogate this proposition, I explore the market dimensions and consequences of corporate growth in the delivery of health services focusing on the period from 1975 to 2025.
Methods
This thesis analyses the strategies that private health service companies use to increase market power and profitability and builds a longitudinal event timeline analysis to map company growth and development. I also use qualitative, semi-structured interviews with leading health experts to explore issues of accountability raised by the expansion of private healthcare companies. Constructing a typology of corporate market strategies, I examine the various forms of power that corporate stakeholders exercise to minimise the risks of government regulation and to maintain their market position.
Results
Through conducting a systematic scoping review, the first empirical chapter identified 22 distinct market strategies used by private hospitals. These fall under six interconnected strategic objectives. The study found that competition policies, particularly those addressing unfair trading practices, corporate expansion and market power abuse, can significantly improve healthcare systems and the delivery of health services. The second study analysed the evolution of ASX-listed health companies to scrutinise the trajectory of increased consolidation and its impact on Australia’s health system. The third study explored the perspectives of healthcare executives, government officials, and health scholars on the opportunities and barriers to ensuring accountability among private health providers. In their responses, participants reveal differing views about the priorities and interests of private healthcare and the extent to which they see private healthcare as prioritising profits or health equity.
Conclusions
Since the 1980s the Australian health sector has been transformed by corporate expansion and consolidation. Exploring corporate power and strategic corporate behaviour in the delivery of public services highlights the influence that corporate actors can have over health services in Australia and globally. This study shows how private actors typically pursue financial interests using growth and consolidation to increase their market position, and the potential risks this poses for public health. This raises key questions for policymakers and health scholars about how to balance public health interests with those of private health corporations. Among the risks of corporate control identified in the study was the increase of corporate power in Australia’s health system and creating the conditions for large companies to become ‘too big to fail’. On balance, this thesis suggests increased corporate growth in private health services can pose considerable risk for patient health and equity. It supports calls for the need of greater attention to the political and commercial determinants of health in policy formation and future public service delivery research.
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Keywords
Health Services, Australia, Commercial Determinates of Health, Corporate Power, Privatisation, Market strategy, ASX, Health policy, Health Sector, History, Health equity, Political economy, Market power, Financialisaton, Health outcomes, Policy, Private Hospitals, Health data, Accountability, Interviews