Describing Health Ecosystem in NIS: The Case of University Hospitals in Turkey

Introduction

Science, technology, and innovation are vital sources for countries in the so-called knowledge-economy era. All developed and developing countries created innovation policies for reaching these sources. Frenken (2017) asserted that there are two mainstreams for innovation policy development. These are market-failure and system-failure approaches. Based on Metcalfe’s (1994) study, market-failure approach, which was contributed by Arrow (1962), Nelson (1959), and Usher (1964), was related to economic peculiarities of knowledge, its production, and dissemination; particularly indivisibilities, uncertainty, lack of appropriability, externalities and public good opportunities. Basically, market-failure may be deemed as a linear model and based on this perspective it is expected that firms underinvest in R&D, because, a part of the outputs of their investments spillover to other firms who imitate innovation without remunerating the originator (Arrow, 1962). Moreover, firms are not expected to raise investment in R&D because of risk and uncertainty about the future outcomes of their investments. Hence, governments with this approach put forward policies on protecting intellectual property rights and providing direct or indirect R&D subsidies to repair such market-failures. Other approach underlines an evolutionary perspective and adopts the behavioral theory of the firm and focuses upon learning processes and adaptive behavior based on Metcalfe’s (1994) study. Systemic nature of this approach focuses on interaction and collaboration. Triple-helix concept is put forward by Etzkowitz and Leydesdorff (2000) in this approach and stressed the benefits of coordination and collaboration between actors.

With this collaborative perspective, discussions bred the systems of innovation idea and “national innovation systems-NIS” was put forward by scholars in innovation field (Lundvall, 2010; Freeman, 1995; Nelson, 1959). It was asserted that Christopher Freeman made his contribution on the systemic perspective of innovation with his innovation system concept by the end of the 1980s. According to Smith (2000) the underlying idea of Freeman could be traced back to List with its institutional aspect and Marx with its combination of a theory of technological change and a theory of development. Lundvall states that: “a national system encompasses elements and relationship, either located within or rooted inside the borders of a nation-state” (Lundvall, 2010, p. 2). Major components of a NIS include organizations (firms, universities, public research institutes), institutions (various laws, regulations, cultural norms), and governments. The main focus of NIS is on non-firm organizations, which provide a contextual background within which innovation can take place. Because of the complex nature of NIS, there were some integrated sub-systems. It can be stated that health innovation sub-system is the biggest component of the national innovation system. Consoli and Mina (2009) describe the health innovation system as in Figure 1.

Figure 1.

Health Innovation System (Consoli and Mina, 2009)

As sketched in figure 1, there were interactions among relevant agents between interconnected layers. The bottom part was described as the practical domain of health innovation system in which the patient-practitioner relationship took place. Our focus is mainly on the upper part of figure 1 and especially the scientific production of research hospitals. It is clear that in this big picture, the scientific community is not limited to research hospitals in the health domain but for computational constraints, we focused on research hospitals and limited our study with these institutions.