Health Network Culture and Reform

Abstract

For policy-makers who favour health system marketization, that is the re-structuring of health systems to mimic the organizational structures and inter-organizational relationships found in markets, networks offer a surrogate governance structure in those parts of a ‘hollowed-out state’ where direct hierarchical control of individuals or organizations has been removed (Etzioni, 2001; Rhodes, 1997), supplementing hierarchies and markets as a ‘third way’ governance structure. Health care networks have correspondingly proliferated and now include professional (’expertise’) networks: clinical referral (’care’) networks; project networks; programme (linkage’) networks such as WHO-style programmes; ‘experience’ networks of users and carers; policy networks (including policy ‘communities’ as a special case); learning networks; and interest networks which promote particular policy or interest-group (Southon, Perkins and Galler, 2005). Meantime, ‘reforms’ of health-care bureaucracies have proceeded apace in many countries as have attempts to re-introduce or extend health-care markets.