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

Document Type : Commentary

Authors

1 Oxford Policy Management Ltd, Oxford, UK

2 Mannheim Institute of Public Health, Universität Heidelberg, Heidelberg, Germany

Abstract

Governance in health is cited as one of the key factors in balancing the concerns of the government and public sector with the interests of civil society/private players, but often remains poorly described and operationalized. Richard Saltman and Antonio Duran look at two aspects in the search for new provider models in a context of health markets signalling liberalisation: (i) the role of the government to balance public and private interests and responsibilities in delivering care through modernised governance arrangements, and (ii) the finding that operational complexities may hinder well–designed provider governance models, unless governance reflects country-specific realities. This commentary builds on the discussion by Saltman and Duran, and argues that the concept of governance needs to be clearly defined and operationalized in order to be helpful for policy debate as well as for the development of an applicable framework for performance improvement. It provides a working definition of governance and includes a reflection on the prevailing cultural norms in an organization or society upon which any governance needs to be build. It proposes to explore whether the “evidence-based governance” concept can be introduced to generate knowledge about innovative and effective governance models, and concludes that studies similar to the one by Saltman and Duran can inform this debate.

Keywords

Main Subjects

References

  1. Lewis M, Pettersson G. Governance in Health Care Delivery. Raising Performance. Policy Research Working Paper 5074. Washington: The World Bank; 2009.
  2. Saltman RB, Duran A. Governance, Government, and the Search for New Provider Models. Int J Health Policy Manag. 2015;4:1-10. doi:10.15171/ijhpm.2015.198
  3. Duran A, Dubois HFW, Saltman RB. The evolving roles of hospitals and recent concepts of public sector governance. In: Saltman RB, Duran A, Dubois HW, eds. Governing Public Hospitals: Recent Strategies and the Movement Toward Institutional Autonomy. Brussels: European Observatory on Systems and Policies; 2011:15-34.
  4. Magretta J. What Management Is. New York: The Free Press; 2003:4.
  5. Kooiman J. Societal governance: levels, models, and orders of socialpolitical interaction. In: Pierre J, ed. Debating Governance: Authority, Steering and Democracy. Oxford: Oxford University Press;2000:138-166.
  6. Mossialos E, Permanand G, Baeten R and Hervey T. Health systems governance in Europe: the role of European Union law and policy. In: Health Systems Governance in Europe: The Role of EU Law and Policy. Cambridge University Press; 2010:3. http://www.euro.who.int/__data/assets/pdf_file/0007/138148/E94886_ch01.pdf?ua=1
  7. Dwyer J, Eagar K. Options for reform of Commonwealth and State governance responsibilities for the Australian health system. Commissioned paper for the National Health and Hospitals Reform Commission. Canberra; 2008.
  8. Savedoff WD. Governance in the health sector. A strategy for measuring determinants and performance. Policy Research Working Paper 5655. Washington: The World Bank; 2011.
  9. Rawls J. A Theory of Justice. Cambridge, MA: Belknap Press; 1971.
  10. Greer SL, Wismar M, Figueras J,  McKee C. Governance: a framework. In: Greer SL, Wismar M, Figueras J, eds. Strengthening Health System Governance. Better Policies, Stronger Performance. Maidenhead: Open University Press; 2016:27-56
  11. Jowett M, Kutzin J. Raising revenues for health in support of UHC: strategic issues for policy makers. Health Financing Policy Brief No. 1. Geneva: World Health Organization; 2015.
  12. Kramer W. Why Aren’t State Exchanges Embracing Prudent Purchasing Strategies? HealthAffairs Blog, March 19, 2012. http://healthaffairs.org/blog/2012/03/19/why-arent-state-exchanges-embracing-prudent-purchasing-strategies/.  Accessed February 19, 2016.
  13. Woolhandler S, Ariely D. Will Pay For Performance Backfire? Insights From Behavioral Economics. HealthAffairs Blog. October 11, 2012. http://healthaffairs.org/blog/2012/10/11/will-pay-for-performance-backfire-insights-from-behavioral-economics/. Accessed February 19, 2016.
  14. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-2. doi:10.1136/bmj.312.7023.71
  15. Pfeffer J, Sutton RI. Evidence-Based Management. Harvard Business Review. January 2006. https://hbr.org/2006/01/evidence-based-management.
  16. Gwatkin DR, Wagstaff A, Yazbeck A. Reaching the Poor. What Works, What Doesn't, and Why. Washington: The World Bank; 2005. doi:10.1596/978-0-8213-5961-7
  17. Saltman  RB,  Duran A, Dubois HF, eds.  Governing  Public Hospitals: Recent Strategies and the Movement Toward Institutional Autonomy. Brussels: European Observatory on Systems  and  Policies; 2011.
  18. Rhodes RAW. The new governance: governing without government. Political Studies. 1996;XLIV:652-667. doi:10.1111/j.1467-9248.1996.tb01747.x
  19. Alvarez-Rosete A. Modernising policy making. In: Hann A, ed. Health Policy and Politics. Aldershot: Ashgate; 2007:41-57.
  20. Moretti F, Pestre D. Bankspeak. The Language of World Bank Reports. New Left Review. 2015;92:75-99.

Files

History

  • Receive Date: 11 March 2016
  • Revise Date: 17 May 2016
  • Accept Date: 14 May 2016
  • First Publish Date: 01 August 2016

Share

How to cite

Statistics