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At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

The Philippine health care system is comprised of both private and public hospitals, clinics, and health care providers, and public health units serve a huge majority of the population because of their number and accessibility to more people in terms of price and location. It is therefore important to examine the performance of these public health units and see if they could become more efficient in the delivery of health services. This study will apply data envelopment analysis (DEA) to assess the efficiency of provinces in providing health care services in order to assist the Department of Health in identifying the performance level of each province, determining the targets for improvements in securing benefits and using resources, and identifying the peers of provinces in the delivery of health care. The data used in this study are taken from the Field Health Service Information System and Philippine Health Insurance System of the Department of the Health and the Statement of Income and Expenditure of the Department of Finance. The following programs were analyzed in this study: Maternal Health Care, Child Health Care, and Environmental Sanitation. These programs’ outcomes comprise the percentage of the prevalence of contraceptive use and fully immunized children, for maternal and child health care programs; and the percentage of people who have access to potable water and sanitary toilets, for environmental sanitation. As for inputs, expenditure efficiency is analyzed by the health unit budget per capita and technical efficiency includes the number of doctors and midwives per 100,000 population and the percentage of rural health units accredited by the Philippine Health Insurance Corporation. The DEA results for efficiency expenditure shows that only 9 out of 77 provinces are efficient in providing health programs given their budgets and the average input efficiency score is 54 percent and the average output efficiency score is 87 percent. As for the DEA results for technical efficiency, 24 out of 77 provinces are efficient in providing health care programs given the percentage number of doctors, midwives, and accredited health facilities by the Philippine Health Insurance Corporation. The average input efficiency score is 79 percent and the average output efficiency score is 80 percent. This study has shown the importance of DEA in analyzing the efficiency of delivery of public health services in provinces using expenditure, number of available health care providers, and the presence of accredited rural health units vis-à-vis environmental sanitation and maternal and child health care programs. DEA can rationalize the allocation of budgets among similar health units in order to further improve the efficiency in the delivery of health services in provinces. Moreover, benchmarking using DEA results can improve the accountability of provincial health units in the utilization of their budgets in order to further increase the reach of province-based health programs which could lead to a marked improvement in the health of Filipinos.

While there is established research that explores individual innovations across countries or developments in a specific health area, there is less work that attempts to match national innovations to specific systems of health governance to uncover themes across nations.

We used a cross-comparison design that employed content analysis of health governance models and innovation patterns in eight OECD nations (Australia, Britain, Canada, France, Germany, the Netherlands, Switzerland, and the United States).

Country-level model of health governance may impact the focus of health innovation within the eight jurisdictions studied. Innovation across all governance models has targeted consumer engagement in health systems, the integration of health services across the continuum of care, access to care in the community, and financial models that drive competition.

Improving our understanding of the linkage between health governance and innovation in health systems may heighten awareness of potential enablers and barriers to innovation success.

So far only minimal efforts have been made to directly integrate health concerns with priorities of the processes of global economic development. Nonetheless, there is search for new models to provide sufficient medical care and to encumber global threats, soaring medical costs, technological costs, poverty, and disease. Using example of health conditions and health policies implemented in countries of Southeast Asia in comparison to Eastern Europe, the chapter emphasizes success achieved and in the process of achievement in provision of health care to societies in these countries.

Purpose: We analyze how medical providers use accountability processes or the regulatory means through which individuals hold themselves or others accountable to social norms, to uphold their medical authority. We use the case of trans medicine because in this medical domain, providers often have little to no expertise and few are trained specifically in delivering trans medicine or working with trans patients. As a result, providers experience uncertainty and are left without the typical tools and expertise on which they depend in most other areas of medical decision-making.

Design/methodology/approach: We conducted in-depth interviews with 23 medical providers and observations of transgender healthcare conferences in the United States between 2012 and 2015.

Findings: Our work offers insight into the provider side of patient-provider encounters and medical decision-making in gender minority health. The first accountability strategy providers employed was to invoke the language of evidence as a method to maintain their authority, in spite of the paucity of scientific evidence that undergirds this emergent medical domain. The second strategy was to mandate compliance by holding trans people accountable to the expectation of acquiescing to medical authority.

Originality/value: We contribute to the scholarship on gender minority health by examining how high power actors use accountability processes to restore order in interactions with trans and nonbinary patients. We demonstrate how enforcement to expectations through accountability processes is a plausible, though oft-overlooked, dimension of health inequalities.

Performance metrics have become widely used and much lamented – about tools for measuring healthcare quality. In this paper, the authors reflect on the development and use of performance metrics in healthcare regulation and clinical practice. Studying multi-actor settings of performance measurement systems in healthcare in Sweden and the Netherlands, the authors show how regulatory agencies (i.e., the inspectorate and national registries), patients, hospitals, and practitioners engage in the constitution of healthcare practices through developing performance indicators that form the input for ranking, ensuing intensive dialogues on what should be measured and accounted for, and to what effects. The authors analyze this process as caring for numbers. The authors discern two practices of caring for numbers: validating and contexting. Validating refers to the practices of making numbers reflect those practices they intend to depict; contexting is about how with the use of numbers specific contexts of healthcare are built. These processes together emphasize the performative character of numbers as well as the reflexive uses of performativity. The paper shows how collaborative and rather pragmatic practices of caring for numbers co-construct specific practices of healthcare. Though this reflexive entanglement of production and use of numbers actors not only constitute specific performance metrics and ranking practices but also perform healthcare.