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The aim of this paper is to examine health care organizations' power structures from the first‐line management perspective. What liable power structures derive from the theoretical bases of bureaucratic, professional and result based organizations, and what power type do health care organizations represent, according to the empirical data? The paper seeks to perform an analysis using Mintzberg's power configurations of instrument, closed system, meritocracy and political arena.

The empirical study was executed at the end of 2005 through a survey in ten Finnish hospital districts in both specialized and primary care. Respondents were all first‐line managers in the area and a sample of staff members from internal disease, surgical and psychiatric units, as well as out‐patient and primary care units. The number of respondents was 1,197 and the response percentage was 38. The data were analyzed statistically.

As a result, it can be seen that a certain kind of organization structure supports the generation of a certain power type. A bureaucratic organization generates an instrument or closed system organization, a professional organization generates meritocracy and also political arena, and a result‐based organization has a connection to political arena and meritocracy. First line managers regarded health care organizations as instruments when staff regarded them mainly as meritocracies having features of political arena. Managers felt their position to be limited by rules, whereas staff members regarded their position as having lots of space and influence potential.

If the organizations seek innovative and active managers at the unit level, they should change the organizational structure and redistribute the work so that there could be more space for meaningful management.

This research adds to the literature and gives helpful suggestions that will be of interest to those in the position of first‐line management in health care.

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.