The Role of Rural Health Entrepreneurship in Community Resilience: a Model of Multidimensional Value Creation

Healthcare providers have been encouraged to become entrepreneurs to fill a widening service gap in depleted rural areas. This paper explores how these entrepreneurs add value, finding a complex multidimensional process of value creation in rural healthcare. Taking a grounded approach, 40 health entrepreneurs were interviewed across the health settings of four European countries characterised by ‘mixed’ public–private healthcare. Through an institutional logic framing, the paper builds a novel process theory of value creation in a rural socio-spatial context. It identifies value creation elements, effects and diverging institutional logics characterised by polysemy and polyphony. Overlaid on the bio-physical layer, areas of healthcare value creation hybridity are identified, with implications for the resilience of rural communities and sustainability of rural healthcare enterprises. By presenting an agent-relative and pluralistic theory of rural healthcare entrepreneurship, the paper adds an understanding of multidimensional value creation and contributes to entrepreneurial context and everyday entrepreneurship debates. This paper deals with the provision of healthcare services in rural areas by non-state actors, especially in the face of the COVID-19 pandemics. It focuses on health entrepreneurship for community resilience in the face of economic and health crises. To fill a widening service gap, created through a withdrawal of the state actors, rural healthcare providers have been encouraged to become entrepreneurs and innovate to meet multiple needs. This research aimed to understand how these entrepreneurs add value, finding a multidimensional process of value creation in rural healthcare. Healthcare entrepreneurs find themselves at the intersection of conflicting goals, needing to perform multiple roles simultaneously. The main implication of this study is that rural healthcare entrepreneurs maintain healthcare standards while providing for their own needs, balancing financial viability and business sustainability, whilst caring for the resilience of their local community and environment.