About this item:

452 Views | 895 Downloads

Author Notes:

Correspondence to: Richard B. Saltman, Email: rsaltma@emory.edu

Both authors were equally involved in developing the concepts and finalizing the text of this article.

The authors would like to thank the journal’s anonymous reviewers for valuable comments and suggestions on a prior version of this article.

The authors affirm that they have no financial or professional conflicts of interest concerning any of the organizations or information discussed in this paper.



  • Health System Governance
  • Health System Reform
  • Primary Care Reform
  • Public Hospital Management
  • Swedish Health Reform
  • Spanish Health Reform

Governance, Government, and the Search for New Provider Models


Journal Title:

International Journal of Health Policy and Management


Volume 5, Number 1


, Pages 33-42

Type of Work:

Article | Final Publisher PDF


A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other public sector decision-makers played a dominant role over health service provision, typically operating hospitals through national or regional governments on a command-and-control basis. In a number of countries, however, this state role has started to change, with governments first stepping out of direct service provision and now de facto pushed to focus more on steering provider organizations rather than on direct public management. In this new approach to provider governance, the state has pulled back into a regulatory role that introduces market-like incentives and management structures, which then apply to both public and private sector providers alike. This article examines some of the main operational complexities in implementing this new governance reality/strategy, specifically from a service provision (as opposed to mostly a financing or even regulatory) perspective. After briefly reviewing some of the key theoretical dilemmas, the paper presents two case studies where this new approach was put into practice: primary care in Sweden and hospitals in Spain. The article concludes that good governance today needs to reflect practical operational realities if it is to have the desired effect on health sector reform outcome.

Copyright information:

© 2016 by Kerman University of Medical Sciences

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).

Creative Commons License

Export to EndNote