Governance, Government, and the Search for New Provider Models
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 lif...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Kerman University of Medical Sciences
2016-01-01
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| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | http://www.ijhpm.com/pdf_3125_ec6da15f2fb9f65443c4a31e652c7137.html |
| _version_ | 1819230565952389120 |
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| author | Richard B. Saltman Antonio Duran |
| author_facet | Richard B. Saltman Antonio Duran |
| author_sort | Richard B. Saltman |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-23T11:31:06Z |
| format | Article |
| id | doaj.art-06aca63e642642f09aa7c6e2dc44e2ec |
| institution | Directory Open Access Journal |
| issn | 2322-5939 2322-5939 |
| language | English |
| last_indexed | 2024-12-23T11:31:06Z |
| publishDate | 2016-01-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-06aca63e642642f09aa7c6e2dc44e2ec2022-12-21T17:48:48ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392322-59392016-01-0151334210.15171/ijhpm.2015.198Governance, Government, and the Search for New Provider ModelsRichard B. Saltman0Antonio Duran1Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USAAllDMHealth, Seville, SpainA 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.http://www.ijhpm.com/pdf_3125_ec6da15f2fb9f65443c4a31e652c7137.htmlHealth System GovernanceHealth System ReformPrimary Care ReformPublic Hospital ManagementSwedish Health ReformSpanish Health Reform |
| spellingShingle | Richard B. Saltman Antonio Duran Governance, Government, and the Search for New Provider Models International Journal of Health Policy and Management Health System Governance Health System Reform Primary Care Reform Public Hospital Management Swedish Health Reform Spanish Health Reform |
| title | Governance, Government, and the Search for New Provider Models |
| title_full | Governance, Government, and the Search for New Provider Models |
| title_fullStr | Governance, Government, and the Search for New Provider Models |
| title_full_unstemmed | Governance, Government, and the Search for New Provider Models |
| title_short | Governance, Government, and the Search for New Provider Models |
| title_sort | governance government and the search for new provider models |
| topic | Health System Governance Health System Reform Primary Care Reform Public Hospital Management Swedish Health Reform Spanish Health Reform |
| url | http://www.ijhpm.com/pdf_3125_ec6da15f2fb9f65443c4a31e652c7137.html |
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