Health Care Governance (HCG)

Health care seems to be in a permanent flux, with changes upon changes affecting the work of all within the healthcare sector and beyond. The current marketisation of the Dutch hospital sector is probably the most visible change, affecting the position of patients, healthcare workers, professional organisations, insurers, managers and policy-makers. But also in other than the cure sectors, significant reforms are taking place. These developments have in common that they illustrate that we can no longer speak of a 'state centered' approach to health care decision-making (if ever we could): more and more actors are drawn into the healthcare arena and mutual dependencies increase considerably. The concept of 'governance' tries to capture these changing steering arrangements in the public sector.

A second, conceptual, change that the notion of 'governance' points at is the multi-layeredness of most of societal processes: not only governments (be they international, national or local), but professional associations, industry, insurers, patient organizations and even work floor levels are involved in the coming about of societal steering. What used to be called the 'micro' or the 'macro' has to a great extent become blurred into e.g. 'networks' by analyses of actual policy processes. The concept of Governance tries to build on this by looking at ways in which different places in which societal steering takes place are connected and what kinds of consequences this has for e.g. the quality and legitimacy of decision-making processes.

The group

The group of Health Care Governance studies the development and consequences of those changing steering arrangements, particularly in the healthcare sectors. The group consists of some 25 researchers with different social science backgrounds such as public administration, science and technology studies, organizational sociology and anthropology. This combination of disciplines places us in a unique position to study both changing 'modes of governnance' and the relation they have with changing positionings of key actors in the field of healthcare (e.g. professionals, patients, managers) as well as the material infrastructures (e.g. information technologies) that are built to form the changing steering relationships. Central questions the group tries to answer in the projects that we are engaged in are:

  • how are power relations affected by the introduction of new modes of governance, and how do these affect the legitimacy of decision-making in the healthcare sectors?
  • how can we explain the working of different modes of governance in relation to each other (seeing the healthcare sector as a hybrid of different modes of governance operating at the same time)?
  • how can learning between actors and between levels of organisation be improved within the context of the public accountability of actors in the public sector and the growing marketisation of healthcare?

Teaching

Teaching of the group takes place in all programs of Erasmus School of Health Policy & Management. In the bachelor's program, members of the group participate in courses on e.g. allocation issues in health care, innovation of healthcare organizations, qualitative research methods and philosophy of the health sciences. In the Master's program Health Economics, Policy and Law, we teach the courses Healthcare governance and Comparative politics. In the Master's program Care Management, we teach the courses on Knowledge management and information management.

The group also participates in several courses offered by the Centre for Management Development in Healthcare. At the PhD level, we are closely affiliated with the national research schools Science, Technology and Modern Culture and the Netherlands Institute of Government.