Many developed countries have seen significant reforms of their health systems for the last few decades. Despite extensive investment in these changes, health systems still face a range of challenges which reform efforts do not seem to have overcome. The purpose of this paper is to argue that there are two particular reasons, which go beyond the standard explanations of changing demographics and disease profiles.
The paper is a commentary based on the literature.
The first explanation relates to the relationship between substantive health care reform and governance reform. These are intertwined processes and the pattern of interaction has distorted both types of reform. Second, reform has multiple meanings and may sometimes be more of an intra-organizational ritual and routine than a coherent plan aiming to bring about particular changes. As such, part of the reason why reform so frequently fails to bring about change is that it was not actually intended to bring about specific changes in the first place. The limited success of reform in recent years, the authors argue, has been a result of the fact that reform has focused too much on the substantive aspects of healthcare, while ignoring the governance aspect of the sector.
As a result, governance has often been obstructed by interest groups inside the system, resulting in paralysis. The authors conclude by arguing that substantive reform of public organizations without an accompanying reassessment of the governance of these organizations are more likely to fail, compared to more comprehensive reform efforts.
This viewpoint piece comes out of some thinking that the authors were involved in as part of a background paper we produced for a project led by Dr Krishna Hort at the University of Melbourne, entitled “Developing a framework and methodology for cross-national research on governance of large health system reform in the Asia Pacific.” The authors would like to express the gratitude to Kris and other members of the team for giving us the opportunity to think about issues of governance and reform as part of this project and for the helpful feedback and advice gained through this process.
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