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The purpose of this paper is to reduce the research gap in private sector participation in the Danish and German health systems, where empirical evidence is still very scarce compared with the impressive accumulation of similar literature in Anglo-Saxon countries.

Based on the findings of two case studies – one Danish and the other, a German hospital – the paper assesses the future potential of different private sector participation strategies in health care.

The assessment is that low-level private sector participation approaches such as outsourcing and concession models remain limited and specialised financing instruments for health care in Denmark and Germany due to legal restrictions and lesser importance being placed on operational financial savings and improved management than on achieving strategic goals. Furthermore, existing approaches do not necessarily prepare the ground for public-private partnerships.

To date, longitudinal studies of private sector participation in health care are almost non-existent for continental Europe, yet critical for the assessment of the outcomes of long-term projects of ten to 40 years' duration. In addition, there is still a need for more international comparisons, especially for studies comparing more than two countries.

Case studies about private sector participation in health care with transnational European or international comparisons are very scarce. The paper, which compares two cases of a Danish and a German hospital, is therefore a contribution to reducing a relevant research gap. To date, private sector participation in the German health system, in particular, has rarely been discussed in international journal publications.