Typology of Public-Private Partnerships in Integrated Care: Evidence from a Municipality in Seoul, Korea

The collaboration between public and private organisations

The evolution of social welfare systems fundamentally reflects the dynamic relationship between the private and public sectors. The PPP model has transitioned from government-centred, vertical governance toward a collaborative framework that emphasises cooperation and networking with diverse private stakeholders [14]. Historically, welfare development was predominantly state-driven, with private organisations largely following government directives. The literature demonstrates that PPPs offer substantial advantages by capitalizing on the complementary strengths and mitigating the limitations of both sectors [15]. The public sector faces inherent constraints—termed ‘government failure’—characterized by bureaucratic, uniform, and inefficient service delivery at scale [16]. Public organisations leverage their institutional capacity to provide resources through local care consultative bodies while fostering private sector engagement and promoting efficient resource utilization through coordinated partnerships. While the private sector contributes innovation and operational efficiency to service delivery, it encounters ‘market failure’ when market mechanisms govern public goods such as social welfare services [17]. For-profit organisations emphasise operational efficiency, cost-effectiveness, and scalability, whereas non-profit organisations prioritise social value, equity, and support for vulnerable populations [18, 19]. The literature suggests these divergent motivations may either conflict—when efficiency-driven strategies undermine public welfare objectives—or complement one another, generating synergistic outcomes when operational efficiency aligns with social goals. The private sector’s flexibility, expertise, and managerial capacity at the frontline of welfare provision position it as an effective catalyst for welfare innovation. Particularly, private participation in public services introduces provider competition, enhancing service quality and promoting cost-effective delivery. Nevertheless, the commercialisation of care services can impede collaboration and coordination among local community groups through barriers in information sharing, beneficiary responsiveness, resource allocation, and joint planning.

Conversely, social economy organisations, including social enterprises and cooperatives, fulfill a vital intermediary function within PPPs [20, 21]. These entities pursue dual social and economic objectives, bridging public institutions and private providers. They facilitate resource and information flows while fostering community engagement [20, 21, 22]. By strengthening coordination and governance within PPPs, social economy organisations reconcile divergent partner motivations and enhance the sustainable delivery of integrated care. Recognising and strategically positioning these organisations is therefore essential for achieving both efficiency and social equity within integrated care systems.

Gidron and colleagues (1992) classified four PPP models based on the burden of financial resources and the responsibility for service supply [21]. First, the government-dominant model, in which the government takes charge of both funding and delivery of care services. This model has long been recognised in the welfare states. Second, the third sector-dominant model, where non-profit or private organisations have significant discretion, either in managing programmes or through political processes during policy implementation or development (p.19). This model is known as the “market model”. Third, the dual model of state/non-profit relations, in which the government and non-profit sector share a responsibility for financing and providing services. Finally, a “collaborative-partnership model”, where the government is responsible for the financial burden, while the non-profit sector or private sector is in charge of providing services. With the introduction of the integrated care policy in 2018, the South Korean government adopted a collaborative model of supporting and managing private organisations through public finance, rather than directly providing care services [8]. This policy shift emphasises PPPs while reducing the government’s direct involvement in welfare service delivery. As local governments are front-line administrative agencies that provide comprehensive care services to residents, it is crucial to encourage non-profit and private organisations to participate and support cooperative initiatives in the integrated care network. Currently, public organisations maintain their functions as funders and planners in integrated care, while social welfare institutions and community organisations, also known as non-profit organisations, deliver care services as service providers [1, 21].

Public-private partnerships (PPPs) are widely recognized in academic and business communities for their significance in delivering social welfare services. Without appropriate collaboration among PPP stakeholders in integrated care systems, administrative confusion and inefficiency can arise due to complicated procedures and potential service duplication between public and private entities [6, 12, 13]. Over recent decades, numerous studies have explored collaborative partnerships between public and private sectors across diverse countries [4, 12, 13]. Recent literature on integrated care networks has described PPP network structures, identified stakeholders, and measured effectiveness [12]. However, Korean studies reveal lacking collaboration between public and private organisations, and even among private organisations [23, 24, 25], attributed to performance-focused assessments, insufficient expertise, and inadequate institutional linkages. These findings indicate insufficient coordination between care organisations, resulting in service redundancy and gaps. While decades of research have examined various aspects of PPP models within welfare service networks, thorough examination of PPP frameworks, specific roles, and responsibilities remains limited. A pragmatic approach is needed to understand and refine the specific implementation status and role allocation required for effective PPPs.

Furthermore, the specific roles of public and private sectors vary across countries [13], depending on contextual problems and social environments. To achieve local community service integration, both sectors must strategically distribute roles according to each community’s specific context. Korean research indicates that public organisations predominantly assume coordinator roles within PPP models for welfare service networks, distinct from private sector functions [23, 24]. However, another study suggests that public organisations also emphasize counseling and service provision similar to private organisations, creating difficulties in differentiating sectoral functions [25]. The absence of structured coordination systems for public-private agreements has resulted in formalized public management, raising concerns that conflicts may arise rather than collaboration. While debate intensifies over restructuring the public-focused service delivery system, the PPP approach for engaging private care organisations remains inadequately addressed. Against this background, brokerage concepts within SNA offer valuable frameworks for developing comprehensive and precise understanding of PPPs in integrated care contexts.

Data source

Data for this study were derived from the 2020 Integrated Care Network Survey in Seoul, which is a locally representative cross-sectional survey. The survey period was conducted for approximately three months, from October 2020 to January 2021. This study investigated all the public-private organisations that participated in integrated care programmes in a community in Seoul, Korea. In early 2019, the research team established a Memorandum of Understanding (MOU) with the District A Office, stipulating that research findings would serve as foundational data for the district’s integrated care initiatives. The District A Office issued official cooperation letters to local community organisations to facilitate data collection and encourage survey participation. Information on integrated care organisations was obtained from the District A Office, which identified 82 public and private organisations across five categories: district offices (5), public health centers (4), healthcare institutions (17), social welfare institutions (37), and community organisations (19). The survey achieved a 100% response rate.

Collaborative relationships among community organisations were assessed by: 1) examining the existence of interaction, collaboration, and cooperative activities, and 2) quantifying collaboration strength using a 5-point Likert scale. To minimize COVID-19 influence, the survey employed self-administered questionnaires distributed via mail and supplemented with in-person visits, with official local government cooperation. Target interviewees included senior personnel engaged in care projects, as well as managers and middle managers familiar with organisational operations (IRB approval numbers: DUIRB-201912-05 and DUIRB-202103-03).

Statistical analysis

Social Network Analysis refers to the study of connection networks in which collaborative relationships between organisations are formed and spread [26]. It involves schematizing the network structure through a sociogram (Figure 1). It is a methodology that quantitatively analyzes the structure, interaction, and cohesion of a social network by modeling the relationship between individuals and groups as nodes and links. This analytical method can intuitively examine the collaborative patterns of public and private organisations participating in care projects for the elderly and the disabled in a community. SNA presents the form and pattern of collaboration between public and private care organisations in integrated care projects through quantified figures and relationship schematics. It can provide important policy implications for establishing an integrated care collaboration system. The purpose of this study was to investigate the structural characteristics and relationships within the network of 82 public and private care organisations in a community.

Figure 1

Here, we employed three methodological designs in the analysis of Social Network Analysis: 1) modularity, 2) eigenvector centrality, and 3) brokerage. First, we performed modularity analysis to assess the collaborative structure within the complex integrated care network. The quality of a community structure is evaluated by modularity, which is determined as the difference between the actual number of intra-community edges and the expected number of such edges. Modularity can decompose a complex network into several subnetworks, where nodes are densely connected. Secondly, we quantified the influence of organisations in the integrated care network by measuring eigenvector centrality. Finally, we analyzed brokerage patterns to identify the key actors and roles of public-private organisations in the integrated care network.

Comparing the brokerage roles between networks for the elderly and the disabled

Brokerage analysis of the elderly and disability care collaborative networks yielded the following results.

Coordinator

In the elderly care network, eleven social welfare agencies functioned as coordinators, including one social service centre, five senior centres, four adult day care centres, and one senior care support centre, each with coordinator scores of 30 or higher. These social welfare institutions facilitate coordination among organisations within the same sector through caregiving information exchange, beneficiary service requests, case management, resource sharing, and joint planning. Notably, neither healthcare institutions nor community organisations fulfilled coordinator roles (Table 2).

Conversely, within the disability care network, only a social economy hub centre and two adult day care centres served as coordinators, with scores ranging from 8 to 11, indicating limited coordinator engagement (Figure 3).

Figure 3

Representative

In the elderly care network, six social welfare institutions achieved representative intermediary scores of 10 or higher: two social service centres, three senior centres, and one senior care support centre. These institutions established working relationships as intermediaries between healthcare and social welfare institutions, either through public organisation facilitation or through direct mediation with healthcare institutions Figure 4.

Figure 4

In the disability care network, four organisations attained representative scores of 10 or higher: a social service centre for the disabled, district offices, two adult day care centres, and a health and welfare cooperative. These organisations, affiliated with various entities, established working relationships with district offices, mediated between organisations across different domains, and created direct connections spanning multiple fields. However, private organisations assumed representative roles less prominently in the disability care network compared to their counterparts in elderly care collaborations (Table 3).

Gatekeeper

In the elderly care network, seven social welfare institutions achieved gatekeeping scores of 10 or higher: two social service centres, three senior centres, one adult day care centre, and one senior care support centre. These institutions functioned as gatekeeping intermediaries between private and public institutions, healthcare organisations, and community organisations, receiving care-related information from external entities and disseminating it within their sectors, thereby facilitating public-private communication Figure 5.

Figure 5

Within the disability care network, only two institutions—district offices and the health welfare cooperative—attained gatekeeping scores of 10 or higher. Although social welfare institutions assumed more prominent gatekeeping roles in the elderly care network compared to the disability care network, their overall involvement remained limited in both networks (Table 4).

Liaison

In the elderly care network, the dementia relief centre achieved a notably high liaison score of 88, playing a crucial role primarily connecting social welfare and healthcare institutions. However, its liaison function for social welfare centres remained limited. In the disability care network, public health centres, district offices, and community service centres attained the highest liaison scores at 415, 377, and 58 respectively, indicating that public institutions fulfilled more critical liaison roles in disability care compared to elderly care networks. Conversely, private organisations—specifically a social service centre for the disabled and the health and welfare cooperative—achieved higher liaison scores (39 and 26 respectively) than their elderly care counterparts (Table 5). These organisations functioned as intermediaries connecting social service centres for the disabled, healthcare institutions, and community organisations Figure 6.

Figure 6

Complexity of collaborative partnerships in integrated care

This study employed network analysis techniques—including modularity analysis, centrality analysis, and brokerage analysis—to examine interaction processes between public and private organisations within the integrated care landscape. Specifically, it investigated the complexity of collaborative public-private partnerships (PPPs) and organisational roles within integrated care networks. First, modularity mapping revealed two distinct collaborative networks: elderly care (n = 29) and disability care (n = 44). Second, eigenvector centrality analysis identified public institutions as occupying central roles within care networks, with certain private organisations ranking second. Third, brokerage analysis demonstrated distinct mediator roles between public and private organisations across both networks. Private organisations, including social service centres and community organisations, functioned primarily as coordinators, representatives, and gatekeepers, while public institutions exerted substantial influence as consultants and liaison intermediaries.