Hospitals in Europe face many challenges, including cost pressures, technological changes, an evolving burden of disease, growing patient expectations, political pressure on public authorities to restructure traditional governance models and, in some countries, increasing competition from the private sector
Hospital governance has received particular attention, reflecting the growing number of political, financial and technical, as well as social and professional, factors that affect decision-making in the hospital sector. Reforms have introduced different models of hospital governance in different European countries.
This policy brief provides an overview of 10 case studies from Western Europe on macro-level arrangements in hospital governance – the structural, organizational and operational architecture of the health system. The aim is to compare the experience of decentralized hospital governance to inform policy-making as there have been concerns about the tradeoffs involved.
The concept of hospital governance represents a relatively new approach to hospital-related policy and health policy analysis. Its emergence since the early 2000s reflects the growing number of political, financial and technical, as well as social and professional, factors that affect hospital sector decision-making. Reforms have introduced different models of hospital governance in different European countries.
Hospital governance conceptually encompasses three increasingly blurred levels of hospital-related decision-making, in the context of each health system. The main "entry point" for this policy brief is the macro-level, mostly government-based, aspect of governance rather than the day-to-day operational management of the micro-level or institutional decision-making at the meso-level. One of the key processes has been an increasing decentralization of the macro-governance of public hospitals, and the role of the private sector has also increased in many countries.
Among public hospitals, there has been a move away from centralized political control towards the introduction of greater institutional autonomy and the use of market incentives. There has also been a trend towards hospital consolidation, driven by concerns over efficiency and quality of care, with the closure of smaller facilities and implications for the ways in which hospitals are being governed.
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