Public Hospital Governance in Asia and the Pacific

Overview

Achieving Universal Health Coverage requires the full engagement of all levels and types of care throughout a nation’s health system. Sustaining Universal Health Coverage requires the efficient use of resources as well as an effective resource mobilization strategy to support the provision of preventive and curative health care across different levels of the health system. In all settings, hospitals account for a very significant proportion of total health expenditures.

It is not uncommon for OECD countries to report spending on inpatient care as the single biggest cost component, consuming one quarter to one third of total spending. It is safe to assume that in the Asian emerging economies, a similar or even larger proportion of total spending on hospitals exists, in part due to the region’s relative insulation from the 2008 financial crisis and consequent slowdown in health spending seen in many European and North American countries.

As such, reforms that aim to improve hospital efficiency are at the center of policies that will effect sustainable achievements in Universal Health Coverage. Given this background, it is actually quite remarkable how limited comparative understanding remains of the leading experiences with hospital reforms in countries of the Asia Pacific region.

This is not because there is limited experience with hospital reform in Asia and the Pacific. The reorganization and restructuring of hospital management in the region has been underway for several decades, with different approaches being tried over time, as is shown in this book. Most reforms are taken up in response to common problems such as waste, inefficiency, failure to serve the poor, substandard quality, high costs, brain drain and public dissatisfaction. Public sector hospitals have implemented wide-ranging changes, generally under policy guidance that aims to increase autonomy and regional organization. The growth of privately owned and operated hospitals has also gained pace, and governments throughout the region are reacting to gain benefits from a mixed hospital system with the goal to improve efficiency, quality and patient responsiveness.

The first volume of case studies clearly shows that hospitals in the Asia Pacific region are undergoing profound changes in their governance and operations. The driving forces behind these adjustments are problems that are common across settings, but the responses are highly adaptive to the national context of a country. The case studies provide a good understanding of the extremely dynamic and resilient nature of public hospital governance, as well as, a respect for the complexities that a governing body responds to.