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Leadership and governance in seven developed health systems

Smith, Peter C.; Anell, Anders LU ; Busse, Reinhard; Crivelli, Luca; Healy, Judith; Lindahl, Anne Karin; Westert, Gert and Kene, Tobechukwu (2012) In Health Policy 106(1). p.37-49
Abstract
This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The paper uses a structured survey to examine critically current arrangements in the seven countries. Approaches to leadership and governance vary substantially, and have to date been developed piecemeal and somewhat arbitrarily. Although there seems to be reasonable consensus on broad goals of the health system there is variation in approaches to setting priorities. Cost-effectiveness analysis is in... (More)
This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The paper uses a structured survey to examine critically current arrangements in the seven countries. Approaches to leadership and governance vary substantially, and have to date been developed piecemeal and somewhat arbitrarily. Although there seems to be reasonable consensus on broad goals of the health system there is variation in approaches to setting priorities. Cost-effectiveness analysis is in widespread use as a basis for operational priority setting, but rarely plays a central role. Performance monitoring may be the domain where there is most convergence of thinking, although countries are at different stages of development. The third domain of accountability is where the greatest variation occurs, and where there is greatest uncertainty about the optimal approach. We conclude that a judicious mix of accountability mechanisms is likely to be appropriate in most settings, including market mechanisms, electoral processes, direct financial incentives, and professional oversight and control. The mechanisms should be aligned with the priority setting and monitoring processes. (C) 2011 Elsevier Ireland Ltd. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Leadership, Governance, Health systems, Accountability
in
Health Policy
volume
106
issue
1
pages
37 - 49
publisher
Elsevier
external identifiers
  • wos:000305106500007
  • scopus:84863392982
ISSN
1872-6054
DOI
10.1016/j.healthpol.2011.12.009
language
English
LU publication?
yes
id
c63ce456-7e28-437a-acc4-dd2aee7d2f7b (old id 2892289)
date added to LUP
2012-07-26 10:26:00
date last changed
2017-11-19 03:08:37
@article{c63ce456-7e28-437a-acc4-dd2aee7d2f7b,
  abstract     = {This paper explores leadership and governance arrangements in seven developed health systems: Australia, England, Germany, the Netherlands, Norway, Sweden and Switzerland. It presents a cybernetic model of leadership and governance comprising three fundamental functions: priority setting, performance monitoring and accountability arrangements. The paper uses a structured survey to examine critically current arrangements in the seven countries. Approaches to leadership and governance vary substantially, and have to date been developed piecemeal and somewhat arbitrarily. Although there seems to be reasonable consensus on broad goals of the health system there is variation in approaches to setting priorities. Cost-effectiveness analysis is in widespread use as a basis for operational priority setting, but rarely plays a central role. Performance monitoring may be the domain where there is most convergence of thinking, although countries are at different stages of development. The third domain of accountability is where the greatest variation occurs, and where there is greatest uncertainty about the optimal approach. We conclude that a judicious mix of accountability mechanisms is likely to be appropriate in most settings, including market mechanisms, electoral processes, direct financial incentives, and professional oversight and control. The mechanisms should be aligned with the priority setting and monitoring processes. (C) 2011 Elsevier Ireland Ltd. All rights reserved.},
  author       = {Smith, Peter C. and Anell, Anders and Busse, Reinhard and Crivelli, Luca and Healy, Judith and Lindahl, Anne Karin and Westert, Gert and Kene, Tobechukwu},
  issn         = {1872-6054},
  keyword      = {Leadership,Governance,Health systems,Accountability},
  language     = {eng},
  number       = {1},
  pages        = {37--49},
  publisher    = {Elsevier},
  series       = {Health Policy},
  title        = {Leadership and governance in seven developed health systems},
  url          = {http://dx.doi.org/10.1016/j.healthpol.2011.12.009},
  volume       = {106},
  year         = {2012},
}