The Australian Journal of Public Administration, vol. 68, no. 1, pp. 39–52 doi:10.1111/j.1467-8500.2008.00608.x RESEARCH AND EVALUATION Co-Production and Health System Reform – From Re-Imagining To Re-Making Roger Dunston, Alison Lee, David Boud, Pat Brodie and Mary Chiarella University of Technology, Sydney There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of post- neoliberal policy concerned with re-imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co-production, has both beneficial, but also problematic implications for the organi- sation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via ‘choice’ and ‘voice’ par- ticipation strategies, the question of how the more challenging approach of co-production will fare needs to be addressed. The article discusses the possibilities and challenges of system-wide co-production for health. It identifies the discourse and practice contours of co-production, differentiating co-production from other health consumer-led approaches. Fi- nally, it identifies issues critically related to the successful implementation of co-production where additional theorisation and research are required. Key words: co-production, health services reform, professional learning Neo-liberal policy regimes have increasingly been rendered problematic by governments over the past two decades. Specific problems identified include the dissolving of the nexus between social and economic policy; the policy focus on privatisation, corporatisation and con- tracting out; and the redefinition of the citizen as consumer, for whom market choice and par- ticipation in market processes was argued as the paramount value (Gallop 2001). As Newman (2001:vii) notes in her analysis of policy de- velopment under New Labour in the UK, such recent policy developments, with their central focus on the reform and modernisation of the public sector, must been seen ‘in the context of deeper shifts in governance based on a re- imagination of the relationship between state and citizen’ – what Ball (2007) refers to as the shift from neo-liberal to post-neo-liberal policy regimes. Three of the most well developed and inter- connected strands of this re-imagining can be seen in the strong discourse and policy empha- sis on active citizenship, deliberative democ- racy and the participation of citizens as co- producers, rather than just consumers, within all areas of public service sector functioning and development. It is within such a discur- sive shift that the idea of co-production has been emerging. Giddens (2003:16), for ex- ample, refers to the ‘co-production of public goods’ as a central component of the ‘ensur- ing state’, and as a process of ‘collaboration between the state and the citizen in the produc- tion of socially desirable outcomes’. Earlier, Yeatman (1994, 1998) used the term, in the context of her reviews of home and community care and disability services, as a way of recon- ceptualising the nature of human services and the contribution of all participants. Much of the thinking informing such an idea of co-production has been emerging as an ap- proach to service and outcomes development that locates citizens (consumers) alongside C  2009 The Authors Journal compilation C  2009 National Council of the Institute of Public Administration Australia