Management reforms in healthcare and their impact on patient safety and universal health coverage
Abstract
Background: Universal health coverage is a human right according to the United Nations Universal Declaration of Human Rights. Healthcare across the world has undergone frequent management reforms during the 20th century. The aim of this review was to investigate the impact of management reforms on patient safety and universal health coverage.
Methods: A MEDLINE search for management in healthcare, patient safety, ethics and universal health between 1990 – 2016 was performed. Articles and literature debating this topic and metaanalyses within the medical and sociocultural fields were reviewed.
Results: Three strategies for healthcare governing were described – principles based on bureaucratic, market management and professional ideals. Market management strategies have increased their impact worldwide since the 1940s, with a claim that professionally run systems are ineffective. The frequent market management reforms may have increased the availability of healthcare, but they were followed by negative effects on patient safety and universal health coverage, particularly for the poor. Governmental bureaucratic systems to protect the public against incompetent practices have lagged behind. Market management reforms were followed by increasing costs due to growning administration. There was no systematic critical evaluation. The market management ideals are incompatible with medical ethics. The view of people as egostic profit maximizers is false according to current research in psychology and evolutionary biology. Professionalism was deemed to be as a more viable alternative for healthcare governance.
Conclusions: The repeated market management reforms were disorganized. They were followed by negative effects on patient safety and universal health coverage. The bureucratic control systems are ineffective. A challenge in the 21st century is therefore to restrict market management trends and to reprofessionalize healthcare.
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DOI: http://dx.doi.org/10.18103/imr.v3i1.237
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