Governance, Organization, and the Market

The healthcare sector is undergoing significant changes and facing major challenges in the form of an ageing population, increasing costs, and limited human and financial resources. This increases the need for a strengthened primary care system and better coordination between levels of care, yet at the same time there is a shortage of general practitioners, and the organization often creates incentives for fragmentation rather than coordination. Healthcare is also expected to manage severe and chronic illnesses while simultaneously providing good accessibility for the wider population.To meet these challenges, knowledge is needed about how governance, organization, and market structures affect the quality and equity of care. The organization of healthcare, along with its governance and reimbursement models, will influence the conditions for collaboration between providers. Market mechanisms and private actors are common features in publicly funded healthcare. The expected efficiency gains from these market mechanisms, such as patient choice systems, rely on patients rewarding high-quality care—but when it is difficult to assess quality, such effects may not materialize. The prioritization between managing chronic diseases and maintaining good accessibility is also influenced by the incentives created by market solutions and governance and reimbursement models.

In line with rising healthcare costs, there is also a trend toward increased alternative private financing, both in terms of private insurance solutions and higher fees for healthcare visits and medications. This introduces new challenges for the healthcare system and risks increasing fragmentation rather than supporting collaboration.

The Centre for Health Governance explores how healthcare organization and governance can be strengthened to promote efficient and equitable care, with a sustainable balance between the needs of patients and the realities faced by providers.