International Journal of Preventive Medicine

: 2020  |  Volume : 11  |  Issue : 1  |  Page : 10-

Joint venture healthcare system as common practice in developing countries: Game changing on assessing health services

Ahmed Al-Mazroei1, Abdulbari Bener2, Mohammed Arif1,  
1 Department of Sustainability and Process Management, School of Build Environment, University of Salford, Salford, UK
2 Department of Biostatistics and Medical Informatics, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK; Department of Public Health, International School of Medicine Istanbul Medipol University, Kavacik, Istanbul, Turkey

Correspondence Address:
Abdulbari Bener
Department of Biostatistics and Medical Informatics, Cerrahpasa Faculty of Medicine, Istanbul University and Istanbul Medipol University, International School of Medicine, 34098 Cerrahpasa-Istanbul


Background: To explore the essence of game changing on applying joint venture (JV) approach for healthcare system improvement in developing countries. Methods: This is cross-sectional study exploring the factors influencing the successful implementation of JV for the healthcare services in low- and middle-income countries (LMICs). The study included: Qatar Statistical Authority, CIA fact book, Ministry of Health Annual Report, Hamad Medical Corporation Annual Report, Organization for Economic Cooperation and Development information, and Qatar's healthcare system history. Results: The research indicated that the LMIC healthcare system would benefit from affiliation with leading technology partner for healthcare reform. The findings support the view of LMIC healthcare systems' needs to incorporate joint venture approach in implementing JV concept for process improvement and knowledge transfer to contribute in country economic growth, development, and stability. Current study explored evidence supporting decision maker and management control of JV trends in different ways in comparison with developed countries. JV can also help the organization to share the risk and cost of large capital investment. Conclusions: The present study supports observations on expending the use of JVs as approach for improvement in LMIC healthcare system. The current study confirmed the advantages of JV which include helping businesses grow faster, increasing productivity, and generating greater profits, both parties sharing the risks and costs, accessing new markets and distribution networks.

How to cite this article:
Al-Mazroei A, Bener A, Arif M. Joint venture healthcare system as common practice in developing countries: Game changing on assessing health services.Int J Prev Med 2020;11:10-10

How to cite this URL:
Al-Mazroei A, Bener A, Arif M. Joint venture healthcare system as common practice in developing countries: Game changing on assessing health services. Int J Prev Med [serial online] 2020 [cited 2020 Jun 4 ];11:10-10
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The increased burden of diseases in low- and middle-income countries (LMICs) cannot be overlooked and noncommunicable diseases are responsible for over 50% of the total worldwide burden of diseases in LMIC.[1],[2]

A joint venture (JV) is a transaction in which two or more firms agree to contribute equity capital to fund as a new company which are created for specific purposes in developed and developing countries.[3],[4],[5] The advantages of joint ventures include: helping cost savings,[6] appropriateness of assessment of satisfaction and performance[7],[8] businesses growing faster, increasing productivity and generating greater profits, both parties sharing the risks and costs, accessing new markets, and distribution networks. International JV is a great opportunity to cooperate with people from different countries and combine strengths.[9],[10],[11],[12] In healthcare system under JV aiming potential for collaboration with hospitals and health systems pursuing partnerships in a number of ways.[13] In fact, JV can achieve increasing their market position, expanding to new markets, having access to new resources, increasing their efficiencies, maximizing economies of scale, driving new revenue streams and growth;[13],[14] although, JV may result outcome as successes or failures.[15],[16],[17]

The objective of this survey is to explore the essence of game changing on process leading to healthcare system improvement in developing countries, investigating main factors effecting the application of JV conception for improvement of healthcare services and delivery in LMIC.


This is a cross-sectional study questionnaire aimed to investigate how the development of JVs can be performed in the improvement of LMICs healthcare systems. The study included: Qatar Statistical Authority, CIA fact book, Ministry of Health Annual Report, Hamad Medical Corporation Annual Report, Organization for Economic Co-operation and Development information, and Qatar's healthcare system history.

At the same time, broad data were collected from journals, white papers, industry websites, and other sources about JV experience in both developed and developing countries with narrative review of particular experience in healthcare industry. We approached 292 participants and 188 (64.3%) responded from the LMIC healthcare services, such as source of supporter, trader, and expert/consultants. The inclusion based on the knowledge of healthcare services, barriers, needs, and strategic plan for JV healthcare improvement.

Student's t test was used to ascertain the significance of differences between two means of a continuous variable and confirmed by nonparametric Mann–Whitney test. Chi-square test and Fisher's exact test (two-tailed) were performed to test for differences in proportions of categorical variables between two or more groups. Principal component analysis with varimax rotation and Kaiser normalization was performed to examine the factor structure of the JV. The level P < 0.05 was considered as the cut-off value for significance.


[Table 1] gives key factors for JV success and improvement of LMIC healthcare system. As can be seen from this table,

developing new skills (72%) and meeting healthcare requirements (72%) were measured as success for JV.

Meanwhile, satisfaction with the overall JV performance indicated as 70% expected, 19% better than expected, and 1% worst (P<0.001).{Table 1}

[Table 2] presents satisfaction level with the JV agreement process. As can be seen from this table most were very satisfied, satisfied, and not satisfied (P = 0.189).{Table 2}

[Table 3] shows the key factors refl ecting company's commitment related to JV. As can be seen from this Table, responces often and very often reflected siginificance differnces between parent company commitment on JV (P<0.001).{Table 3}

Meanwhile, the JV performance activities, as compared with initial expectations at the time the business venture was formed, were as follows: cost control (77%), business climate (80%), management capability (81%), technology transfer (69%), need for parent involvement (85%), customer service (81%), interpartner trust (85%), interpartner cooperation (85%), interpartner cooperation (4%), and achievement of strategic aims (77) (P<0.001).

[Table 4] presents exploratory factor analysis using varimax rotation for the elements of trust concerning Partner Company. The analysis based on the 21 items produced four factors with Cronbach's alpha's for the underlying factors were 0.81, 0.85, 0.87, and 89 which the figures are greater than 0.70, which is a very good indicator of reliability.{Table 4}


The current study aimed to assess the impact of quality in affiliation with experience of foreign international partner JV and accordingly reducing the risk of environmental uncertainty. The most important determining JV issues for partners are: trust, composition of governing bodies, strategic compatibility, formal structure, interaction, and communication between partners. This is confirmative with previously reported studies.[3],[4],[5],[8] The new forms of coordination, including association and close cooperation between companies, influence how tasks should be designed and practiced.[16]

The most important factor regarding JV success for the improvement of LMIC healthcare approach was 72% related to the developing new skills and meeting healthcare needs activities. These cover strengths, weakness, gaps, and opportunities in healthcare system.[18] Further, the trust between partners is essential; in this study, 83% was considered as high degree of trust between partners which is considered important for mutually constructive relationship. This is supported with the previously reported study.[11] This approach can normalize the relationships between firms, reduces complex agreements, permits information exchange, and reduces transaction costs.[17] About 73% indicated their satisfaction was expected. This is in line with the previous studies which reported that more than half of their companies' JVs met or exceeded expectations.[19],[20],[21]

Several studies support the idea that partners are willing to establish partnership with foreign firms to enhance their competitive position, transfer technology, expand to foreign markets, benefit from new sources of finance and the government's financial incentives, and learn new management practices.[19],[20],[21] Further, the effects of technology transfer on the local companies' corporate and human resource performances are not sufficient yet[22],[23] (Yin and Bao 2006). Furthermore, in most JVs and much more in developing countries culture aspect and political environment plays a critical role in the JV success.[24],[25],[26] Currently, hospitals and health systems are rapidly increasing using joint ventures to meet multiple goals, such as providing high-quality care, expanding services, dividing risk and greater profit.


The current study showed that the primary priority in LMICs has been moved more toward the need for development in the quality and efficiency of health services. Factors influencing JV in healthcare services and quality can be improved by leadership, strategic planning, education and training, effective management, allocated availability of human and financial resources, employees and processes, collaboration, and cooperation among providers. Overall, the current study confirmed advantages of joint venture include helping businesses to grow faster, increasing productivity, and generating greater profits, both parties sharing the risks and costs, accessing new markets, and distribution networks. The results suggest International JV contributes to country growth and stability.


This work was generously supported by School of Build Environment, University of Salford, Salford, UK. The authors would like to thank the University of Salford for their support and ethical approval.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Abegunde D, Mathers C, Adam T, Ortegon M, Strong K. The burden and cost of chronic disease in low income and middle income countries. Lancet 2007;370:1929-38.
2Bener A, Zirie M, Kim EJ, Al Buz R, Zaza M, Al-Nufal M, et al. Measuring burden of diseases in a rapidly developing economy: State of Qatar. Glob J Health Sci 2013;5:134-44.
3Bener M, Glaister K. Perceptions of cultural differences and the management of culture in international joint ventures. Int J Strateg Bus Alliances 2009;1:150-81.
4Bener M, Glaister K. Determinants of performance in international joint ventures. J Strategy Manag 2010;3:188-214.
5Bener M, Glaister K. Comparing domestic and international joint ventures: Aspects of management and performance, strategic alliances for value creation. Charlotte: Information Age Publishing; 2011.
6Hennart JF. A Transactions costs theory of equity joint ventures. Strateg Manag J 1988;9:361-74.
7Killing PJ. Strategies for Joint Venture Success. New York: Praeger; 1983.
8Choi CB, Beamish PW. Split management control and international joint venture performance. J Int Bus Stud 2004;35:201-15.
9Tsang EW. Acquiring knowledge by foreign partners from international joint ventures in a transition economy: Learning-by-doing and learning myopia. Strateg Manag J 2002;23:835-54.
10Dyer JH, Chu W. The role of trustworthiness in reducing transaction costs and improving performance: Empirical evidence from the United States, Japan, and Korea. Organ Sci 2003;14:57-68.
11Morgan RM, Hunt SD. The conunitment trust theory of relationship marketing. J Mark 1994;58:20-38.
12De Ruyter K, Moorman L, Lemmink J. Antecedents of commitment and trust in customer-supplier relationships in high technology markets. Ind Mark Manag 2001;30:271-86.
13Totten MK, Knecht PR. Improved joint venture performance through enhanced governance best practices for strengthening hospital partnerships. Workbook, November 13, 2017.
14Geringer JM, Hebert L. Measuring performance of international joint ventures. J Int Bus Stud 1991;22:249-63.
15Groot TL, Merchant KA. Control of international joint ventures. Account Organ Soc 2000;25:579-607.
16Håkansson H, Lind J. Accounting and network coordination. Account Organ Soc 2004;29:51-72.
17Minh C. Successful international joint ventures case study of the evergreen vietnam corporation. Int Integr 2013;6:76-89.
18Robson MJ, Leonidou LC, Katsikeas CS. Factors influencing international joint venture performance: Theoretical perspectives, assessment, and future direction. Manag Int Rev 2013;42:385-418.
19Tatoglu E, Glaister K. Strategic motives and partner selection criteria in inter- national joint ventures in Turkey: Perspectives of western firms and Turkish firms. J Glob Mark 2000;13:53-91.
20Demirbag M, Mirza H. Factors affecting international joint venture success: An empirical analysis of foreign-local partner relationships and performance in joint ventures in Turkey. Int Bus Rev 2000;9:1-35.
21Madhok A. How much does ownership really matter? Equity and trust relations in joint venture relationships. J Int Bus Stud 2006;37:4-11.
22Yin E, Bao Y. The acquisition of tacit knowledge in China: An empirical analysis of the 'supplier-side individual level' and 'recipient-side' factors. Manag Int Rev 2006;46:327-48.
23Yin RK. Case Study Research: Design and Methods. 4th ed. Thousand Oaks, California: Sage Publications; 2009.
24Child J, Yan Y. Predicting the performance of international joint ventures: An investigation in China. J Manag Stud 2003;40:283-320.
25Inkpen AC, Currall SC. The co-evolution of trust, control, and learning in joint ventures. Organ Sci 2004;15:586-99.
26Power MJ, Desouza KC, Bonifazi C. The Outsourcing Handbook: How to Implement a Successful Outsourcing Process. London: Kogan Page; 2006.