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Through the example of a “regulatory ranking” – an index produced with the aim to regulate the pharmaceutical market by pushing companies in the direction of providing greater access to medicine in developing countries – this chapter focuses on indexing and ranking as infrastructural processes which inscribe global problem spaces as unfolding actionable territories for market intervention. It foregrounds the “Indexal thinking” which structures and informs regulatory rankings – their aspiration to align the interests of different stakeholders and to entice competition among the ranked companies. The authors detail the infrastructural work through which such ambitions are enacted, detailing processes of infrastructural layering/collage and patchwork through which analysts naturalize/denaturalize various contested categories in the ranking’s territory. They reflect on the consequences of such attempts at reconfiguring global topologies for the problems these governance initiatives seek to address.

The twentieth century started writing the history of modern health systems. Their evolvable rate is now higher than ever. The Western Europe was the forefront of setting up the national health systems (NHS) to protect citizens and let them thrive. Successful models progressively crossed the borders and experiences became universal. Hence, this chapter tackles data to perceive the underwent radical transformations and capture intricate aspects to envision the next and get answers time ahead the patients‘needs. Health organizational structures and human resources management play crucially in improving system’s performances: managerial qualities, medical entities’ functionality, results’ forecasting are essential to build up credibility and aid strategic patterns to evolve.

Changes are welcome to better tailor performances, assure successful implementation, avoid inadequate, distressing reforms. Stable and consistent policies are also called for.

Grounded on fundamental patterns, open to applicatory innovation, countries follow specific arrangements to resound with healthcare robustness if goals are well-thought-of: keeping people healthy and safe, identifying and treating defectiveness or abnormal physiological functions affecting people, operations, circuits, and preserving health budget wisely balanced.

Activities and citizens are touched by any structural changes maneuvered. To confront them, a keen eye should be addressed to those nobody’s areas into synergistic efforts to cope with internal causes, face external forces and improve life through fair profitability on the way of full satisfaction.

This chapter examines the role of pharmaceutical patents in the on-going support of pharmaceutical innovation. The social value of pharmaceutical innovation and the importance of its sustained growth are explained. The government buy-outs of patents to reduce drug prices for all American consumers while preserving vital drug innovation are proposed.

In Saudi Arabia, quality management receives a significant amount of attention in higher education. In medical education, specifically, Saudi colleges have been fully engaged with quality assurance and accreditation since 1992, under the supervision of the Saudi Council for Health Specialties. Along with the quality standards determined by accreditation agencies, the perspective of employers on the quality of learning and teaching needs to be acknowledged. The needs of medical employers can be translated into quality standards for medical education to help overcome the perceived deficiencies which lead to poorly equipped graduates. This chapter explores how employers conceptualize quality in medical education with an emphasis on learning and teaching and employers’ perspectives on the quality attributes of medical graduates. This chapter is based on interviews with 14 medical employers in Saudi Arabia. From the employers’ perspective, a high-quality medical education is marked by high quality educational systems, curricula, faculty members, and medical training. Additionally, medical graduates must attain a balance of soft skills, practical and clinical skills, and theoretical medical knowledge. Understanding employers’ perspectives on quality in medical education will complement our existing understanding of quality in medical education.

The identification of country-specific advantages for business activities is one of the most crucial issues of strategic management and international business literatures. We address this issue by examining location-specific conditions for a successful generic medicines industry within 24 European countries. The findings of our fuzzy-set qualitative comparative analysis show that there are no necessary conditions for the high performance or absence of the high-performance industry. By revealing the causal complexity related to the issue, however, we show that the high performance or lack of it results from a configuration of conditions. Specifically, we identify two sufficient causal configurations to both outcomes. These findings provide clear implications for generic medicines industry firms who are planning location choices of their operations. In addition, this study provides a methodological advancement to explain and understand which country elements matter more, for what outcomes, and under what conditions.

Purpose – Although the US has lagged behind international developments in health technology assessment (HTA), renewed interest in HTA in the US has been fueled by the appropriation of $1.1 billion comparative effectiveness research (CER) in 2009 and the debate over health care reform.

Approach – To inform CER practices in the US, we present case studies of HTA from England/Wales and Germany: contrasting methods; relevance to the US; and impact on innovation.

Findings – The National Institute of Health and Clinical Excellence (NICE) was established in 1999 to inform trusts within the National Health Service of England and Wales. It uses cost-effectiveness analysis to guide the allocation resource across preventative and curative interventions. In Germany, the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) was established in 2004 to inform reimbursement and pricing policies for the statutory sickness funds set by the Gemeinsamer Bundesausschuss (G-BA). IQWiG evaluates competing technologies within specific therapeutic areas, placing more weight on clinical evidence and the relative efficiency of competing therapies.

Practical implications – Although having deep political and cultural antecedents, differences between NICE and IQWiG can be explained by perspective: the former guiding resource allocation across an entire system (macro-evaluation), the latter focusing on efficiency within the bounds of a particular therapeutic area (micro-evaluation). Given the decentralized nature of the US health care system, and the relative powers of different medical specialties, the IQWiG model presents a more suitable case study to guided CER efforts in the US.

The following is an introductory profile of the fastest growing firms over the three-year period of the study listed by corporate reputation ranking order. The business activities in which the firms are engaged are outlined to provide background information for the reader.

Purpose: This chapter describes the main features of the financing of health care expenditure in the French health care system.

Methodology/Approach: This chapter presents key reforms that have been implemented to make the health care system more sustainable in the main dimensions of care: ambulatory, hospital, pharmaceuticals and insurance coverage.

Findings: Overall, French public authorities have followed three paths to improve the sustainability of the health care system: reducing public expenses, generalising access to complementary health insurance and streamlining care toward the most disadvantaged individuals. Looking in the future, the sustainability of the French health care system will mainly rely on two areas of recommendations. The first area is to respect the national annual target for health insurance spending, with a focus on responsible prescriptions, optimised care pathways and increased use of primary and ambulatory care where possible. The second area is to increase efficiency on the short to medium terms. This includes an increased quality of the care toward patients with a disability or special needs, a clearer engagement of patients within their care pathways to increase treatment compliance, and more generally a search for coordinated care that is fair and appropriate.

This paper examines how cultural holes that exist at the intersection of institutional fields influence the exploitation of entrepreneurial opportunities. Through an exploration of physician-founded ambulatory surgery centers in the United States, we examine how the presence of cultural holes presented doctors with alternative beliefs, values, and practices to overcome the cultural constraints around entrepreneurship within the medical profession. In doing so, this study extends cultural entrepreneurship research by bringing cultural holes to the forefront, empirically showing how they facilitate entrepreneurial action and proposing other contexts where cultural holes may affect entrepreneurial actions and outcomes.