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The allocation of resources is a complex problem in health care. In Finland there has been an effort to solve the problems with a program called “Securing the Future of Health Care”. The main focus of this research is on assessing how managers view the health care policy called guarantee of care from an ethical perspective.

The theoretical basis of the research covers theories regarding rationing, prioritization, as well as the ethics of health care. The empirical data were gathered through an internet questionnaire. The questionnaires were sent to the top managers in all Finnish health care districts (20 in all). The data were analyzed qualitatively.

According to respondents, ensuring access to treatment partially fulfilled the ethical principles of the right to good care, respect for human dignity, fairness, and co‐operation and mutual respect quite well. On the other hand, trust, impressiveness, non‐partiality in decision making and the right of self‐determination were not as well realized. The shortening of waiting lists had caused exhaustion and motivation problems among personnel and in addition, staff shortages were being experienced.

The administrators of the hospital districts agreed that centralizing resources as a reconstructive action is ethically wrong for the whole health care system. There is a great need for an ethical discussion concerning the choices made in health care policy. Long‐term results need sustainable solutions.

Health care organizations function in multidimensional environments, and their organizational cultures are complex and demanding. Expectations for health care services are high: patients want the most effective and newest possible treatments, politicians demand accountable service production, and health care professionals require motivating and challenging work environments. All these goals and objectives, for example, can be at the root of wicked problems in health care management. Thus, this chapter aims to explore the wickedness of health care management through an analysis of Finnish and Swedish health care reforms. The aim of these reforms is to solve the problems encountered in health care systems and organizations. The concept of a ‘wicked issue’ can shortly be described as a problem that is difficult to identify and solve. The reasoning behind using the concept of wicked issue as a method for analysis here is the hypothesis that the concept helps to explain and understand the social complexity involved in health care management.

We hope this research volume will change the way scholars and managers think about health care management in two fundamental ways. First, we want to challenge the superficial separations between national and international health care management. To dissolve these distinctions, the “not-invented-here” or “who cares about a Belgian, Indian, or Thai medical center,” or “that won’t work in our policy system” attitudes must change. Second, we want scholars and managers to learn how to transfer innovative ideas and management practices across cultures and around policy barriers. Cultural, language, and policy differences present formidable barriers, but we believe lessons about managing human resources, informatics, quality, services, and strategies in health care organizations can be transferred.