Formal Institution Networks and Coopetition: Insights from the Brazilian Private Healthcare Industry

This study demonstrates that formal institution networks are antecedent to firms adopting coopetition to improve performance. The influence of formal institution agents to foster coopetition within an industry is driven by fragilities in the institutions of emerging economies. We studied the Brazilian healthcare sector, which is characterized by strong regulation and government support. We analyzed how and to what extent coopetition relates to formal institution agents and the performance of private healthcare operators. The study employs a quantitative methodology with a sample of 149 firms from the Brazilian private healthcare system through partial least squares structural equation modelling (PLS-SEM). Our findings highlight that networks facilitated by formal institution agents precede firms’ adoption of coopetition to enhance performance. They also underscore the impact of regulatory policy on firms’ strategies and behaviors in the healthcare sector. Our findings emphasize that formal institution networks alone do not guarantee performance improvement. Healthcare firms must develop coopetitive strategies to create and capture value within these relationships. Our study sheds light on the organizational dynamics within the Brazilian private healthcare sector and provides insights for managers and policymakers. For policymakers, it highlights opportunities and challenges in enhancing healthcare sector competitiveness, emphasizing the importance of considering the institutional environment. For healthcare firm managers, it details opportunities for developing coopetitive strategies. Finally, the study is subject to boundary conditions potentially limiting the generalizability of its findings to a broader global context. Additionally, it is also limited by the cross-sectional design since respondents’ replies are specific to the current scenario in the healthcare sector.