National health objectives for the upcoming decade (Healthy People 2010) will soon be established, organized around a vision of "healthy people in healthy communities" and several broad goals. Many of these objectives are increasingly difficult to redress because they are recalcitrant to simple interventions and often require more multi-factorial solutions. While the Healthy People 2010 goals and objectives are well integrated into public health agency thinking, these organizations are insufficiently equipped and under funded to independently achieve their accomplishment. Therefore, collaboration across the health care delivery industry of public and private providers is essential in addressing the complex health problems targeted by Healthy People 2010. At issue is how private sector health care organizations might be induced or enticed to include the national agenda in their own visions, goals and, ultimately, in their operations. Clearly the Healthy People 2010 goals are relevant to both public and private sector organizations, but the manner in which they are relevant hints at the differences between the public and private sectors. Goal 1: Increase Quality and Years of Healthy Life. The specific objectives currently being considered in reference to this goal address mortality rates, life expectancy, years of potential life lost, health status, healthy days, activities of daily living, and years of healthy life. Public sector attention to these objectives can be viewed as stemming from factors such as: Community livability indexes that indicate quality of life; preference for decreasing (or refocusing) financial assistance allocated to individuals with decreased abilities; need for a healthy workforce and taxpayer base; concern for the welfare of citizens; and the belief that all entitled to a health life. In contrast, private sector attention to such objectives seems to stem from another set of factors: Wanting a good "report card" on the quality of services; not wanting sick patients; and viewing potential customers and markets in terms of "the better off they are, the better business will be." Goal 2: Eliminate Health Disparities. The specific objectives currently being considered in reference to this goal address disparities due to race/ethnicity, socioeconomic status, gender, age, geographic location, and disability. The public sector attends to health disparities because of factors such as the effects of disparity on the tax base of a community and correspondingly the distribution of tax dollars; and a social responsibility and philosophy of equality and equity. The private sector attends to health disparities because of a different set of factors such as the marketing potential in being viewed by the public as being equitable, and patients with health disparities being more likely to have minimal or no sources of payment. Theoretical Framework: While these global generalizations may have some truth, a more refinded analysis is needed to productively involve both sectors. Four classical theoretical perspectives from organization science are informative for this discussion: Strategic planning, resource dependence theory, institutional theory, and decision making theory. Each perspective provides insight into the challenges of engaging both the public and private sectors in actions designed to help achieve the Healthy People 2010 goals; and each theoretical perspectives highlights a different external force that shapes the internal process of health care organizations. A particularly relevant theme common across these theoretical perspectives is the role of the organizational environment in shaping the internal processes of the organization. Strategy highlights mission as a guide to selecting environmental opportunities, resource dependence emphasizes funding sources and exchange relationships, institutional theory accentuates the importance of constituents, and decision making underscores data availability and use in decision making. These four theoretical perspectives apply to both sectors and reveal how approaches can be tailored to each sector. CONCLUSIONS: From the theoretical analysis, public and private sector health care organizations have complementary and non-duplicative roles to play in contributing to achieving the Healthy People 2010 goals. Health care organizations in public and private sectors respond to different pressures but organizations in both sectors have an interest in engaging in efforts that are aligned with the Healthy People 2010 goals. IMPLICATIONS: The roles, motivations, and operations of public and private sector health care organizations can be intentionally and purposefully aligned toward achieving the Healthy People 2010 goals.
