Summary of Rewriting the Rules of the Game in Health Care

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National health systems around the world are striving to provide better value in health care. At the same time, they struggle with outdated, fragmented systems and rapid change. The key to health system transformation, according to a team of experts from Boston Consulting Group: good governance. In this thorough, clearly presented guide, senior partner Stefan Larsson, partner Jad Bitar, principal Emile Salhab and consultant Krystelle Hanna offer recommendations for leaders planning and implementing health system redesigns – from narrowly defined goals to comprehensive change. 

About the Authors

Stefan Larsson is a senior partner and managing director at Boston Consulting Group (BCG) and the global leader of the health systems sector. Jad Bitar is a partner and managing director, and Emile Salhab is a principal, at BCG; both are core members of the Health Care practice. Krystelle Hanna is a consultant at BCG.



National health systems need good governance to meet the challenges of providing health care value.

National health systems are encountering pressures to increase efficiency, deliver better and more consistent health outcomes, and operate amid rapid, often disruptive change. Unfortunately, many systems have, over time, become poorly integrated hodgepodges of functions and structures – similar to IT legacy systems; they require transformation. That transformation depends on governance of the health sector, yet the governance structures themselves typically suffer from gaps or overlaps in areas of responsibility. Such gaps lead to conflicts and lack of clarity – and shortfalls in regulatory expertise and competence.

Good governance provides guidance and planning for a health system. It establishes policies, regulations and standards, oversees performance, and supports key elements of the system. Governance systems should be population-centric, nationally holistic, accountable, trusted, dynamic, complementary and cooperative, and strategic and focused. Embracing these seven principles in the design of health system governance...

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