There are many forces driving and governing health care, such as patients, healthcare service providers, insurance systems, as well as the parliament with its forms of regional, local and corporate governance. Social media is an important tool of these driving forces, which enables users to network on the Internet (e.g. TV, Press, interest groups, consulting offices and unions); while sustainable governance helps a company to implement strategies, manage goal-setting and reporting processes, strengthen relations with external partners, and ensure overall accountability. Finally leadership and stewardship serve as alternative steering systems in this sector. Bad governance (inefficiency, red tape, maladministration, corruption and secrecy) and good governance (rule of law, transparency, accountability and sustainability) are all part of this picture.
Do all these forces build the foundation for health governance together with competition, the market and central planning with all its bureaucracy? Is Governance - including fiscal, self, economic, medical and political governance with all its issues and elements - everywhere?
What is hype?
Hype governance is used everywhere and for many purposes. The term health governance is therefore not needed because it can mean what you want it to mean. It is a form of advertising that is very unusually aggressive or spectacular. Everyone talks about health governance but nobody really knows how to use it. Concerted action is, therefore, indispensable for an accessible understanding of health governance from an entrepreneurial and policy perspective.
The so-called ‘Gartner hype-cycle’ shows invention, unrealistic expectations, a valley of disappointment, realistic pathways and finally a level of productivity of new technology. It claims to provide a graphical and conceptual presentation of the maturity of emerging new goods and services through all these phases. But it is hardly applicable in healthcare.
Governance in healthcare
The premise that good governance will ultimately lead to better health outcomes has been central to the proliferation of work in this area over the past decade. Health coaching to improve healthy lifestyle behaviors is part of this approach. Kickbusch/Gleicher, 2018, define health governance as “actions and means a society adopts to organize itself for promoting and protecting the health of its population”. But there are so far no specific prescriptions for these actions and means. For e.g., there are no explicit health expenditure quotas, optimal forms and structures of financing or optimal numbers of fiscal agents in healthcare.
Within the allocation of resources in healthcare, the explanatory value of governance differs significantly in different European health systems, regardless of whether they are funded by taxes (Beveridge) or within a social security system (Bismarck). According to the WHO these challenges to health policy include a lot more, such as those listed below:
• Ensuring equitable access to health care services
• Emphasizing the importance of empowering citizens and patients
• Using resources efficiently by such means as health technology assessment
• Monitoring and evaluation
• Aligning research objectives and policy needs
• Interconnecting primary and specialized care and
• Training human resources, which includes strengthening the role of universities
All these issues could have something to do with the notion of health governance. But they do not give an answer to the question, “What is governance for health?” Is there a take home message?
The term ‘governance’ is not needed because it can mean what an individual author wants it to mean, and not only in health care. It is arbitrary so that the explanatory value of governance differs far too much within the sectors and issues in health care. Perhaps, at least the above mentioned definition by Kickbusch may help in some cases.
What is it that remains?
• The driving forces which govern the healthcare system. These are of great importance, particularly social media and the interest groups.
• Influencing individual lifestyles and behavior as a possible part of good governance in healthcare.
• Health and patient coaching in a local environment, such as a region or a particular town, for a specific population group and/or for a certain disease.
To sum up, path dependencies, stop and go interventions and social piecemeal engineering will remain in the foreground.