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Between substance and governance: Healthcare governance and the limits to reform

机译:在实质与治理之间:医疗保健治理和改革的局限性

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Purpose - 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. Design/methodology/approach - The paper is a commentary based on the literature. Findings - 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. Originality/value - 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.
机译:目的-在过去的几十年中,许多发达国家看到了对其卫生系统的重大改革。尽管对这些变化进行了大量投资,但卫生系统仍面临一系列挑战,而改革努力似乎尚未克服。本文的目的是争论有两个特殊原因,它们超出了人口统计和疾病状况变化的标准解释。设计/方法/方法-本文是基于文献的评注。调查结果-第一种解释涉及实质性医疗改革与治理改革之间的关系。这些是相互交织的过程,相互作用的模式扭曲了两种类型的改革。其次,改革具有多重含义,有时可能是组织内部的仪式和例行公事,而不是旨在实现特定变化的连贯计划。因此,改革如此频繁地无法带来变革的部分原因是,改革实际上并非旨在首先实现特定的变革。作者认为,近年来改革的成功有限,是由于这样一个事实,即改革过于关注医疗的实质性方面,而忽略了该部门的治理方面。原创性/价值-结果,治理常常受到系统内部利益集团的阻碍,从而导致瘫痪。作者的结论是,与更全面的改革努力相比,对公共组织进行实质性改革而没有重新评估这些组织的治理的可能性更大。

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