Governance, Government, and the Search for New Provider Models

Document Type: Debate

Authors

1 Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA

2 AllDMHealth, Seville, Spain

Abstract

A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other public sector decision-makers played a dominant role over health service provision, typically operating hospitals through national or regional governments on a command-and-control basis. In a number of countries, however, this state role has started to change, with governments first stepping out of direct service provision and now de facto pushed to focus more on steering provider organizations rather than on direct public management. In this new approach to provider governance, the state has pulled back into a regulatory role that introduces market-like incentives and management structures, which then apply to both public and private sector providers alike. This article examines some of the main operational complexities in implementing this new governance reality/strategy, specifically from a service provision (as opposed to mostly a financing or even regulatory) perspective. After briefly reviewing some of the key theoretical dilemmas, the paper presents two case studies where this new approach was put into practice: primary care in Sweden and hospitals in Spain. The article concludes that good governance today needs to reflect practical operational realities if it is to have the desired effect on health sector reform outcome.

Highlights

Commentaries Published on this Paper

  • Risks and Opportunities of Reforms Putting Primary Care in the Driver’s Seat; Comment on “Governance, Government, and the Search for New Provider Models”

          Abstract | PDF

  • Governance: Blending Bureaucratic Rules with Day to Day Operational Realities; Comment on “Governance, Government, and the Search for New Provider Models”

          Abstract | PDF

  • New Provider Models for Sweden and Spain: Public, Private or Non-profit?; Comment on “Governance, Government, and the Search for New Provider Models”

          Abstract | PDF

  • Governance in Health – The Need for Exchange and Evidence; Comment on “Governance, Government, and the Search for New Provider Models”

          Abstract | PDF

  • Governance Must Dive Into Organizations to Make a Real Difference; Comment on “Governance, Government, and the Search for New Provider Models”

          Abstract | PDF

 

Authors’ Response to the Commentaries

  • Provider Governance; A Basic Blackbox Seldom Looked at Properly: A Response to Recent Commentaries

          Abstract | PDF

Keywords

Main Subjects


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