Power to the people? An international review of the democratizing effects of direct elections to healthcare organizations

Abstract

Summary Ensuring that publicly funded health systems are democratically accountable is an enduring challenge in policy and practice. One strategy for enhancing public officials' accountability is to elect members of the public to oversee their performance. Several countries have experimented with direct elections to healthcare organizations. The most directly comparable examples involve some Canadian regional health authorities, New Zealand district health boards, foundation trusts in England and health boards in Scotland. We propose three aspects of the process by which the democratizing effects of elections should be judged: authorization, accountability and influence. Evidence from these countries suggests that the democratization of health systems is a complex task, which cannot be completed simply by introducing elections. Copyright © 2015 John Wiley & Sons, Ltd.

The theory and practice of integrative health care governance

“…Democratic governance is not common, with New Zealand the only country in the world to feature this across an entire public health care system for a sustained period (Gauld, 2010;Laugesen and Gauld, 2012). Canada has experimented with it, as has Scotland (Stewart et al, 2016). There have been investigations in England into the feasibility of democratic governance in the NHS (Local Government Association Health Commission, 2008).…”

“…Public interest in elections tends to be unsatisfactory. Turnout tends to be around 50 per cent for New Zealand's elections; in Canada and Scotland this has been significantly lower (Gauld, 2010;Stewart et al, 2016). In New Zealand, those elected are often high-profile public figures but do not necessarily bring the skill range required for governing a complex local health system (Gauld, 2010).…”

Consumers or Citizens? Whose Voice Will Healthwatch Represent and Will It Matter? Comment on "Challenges Facing Healthwatch, a New Consumer Champion in England"

“…1-7 However, identifying successful efforts is more challenging, owing to the lack of a clear definition of PPI and conflicting rationales for its existence. 8 While patients have occasionally proven able to contribute to healthcare planning and development, 9 failures to implement effective consumer governance in healthcare can be found in Canada, 1 the United Kingdom, 3 and the United States.…”

“…Political scientist, Suzanne Dovi, stresses that “Not only do some voices need to be brought in, some voices need to be muted.” 20 Notably, there is evidence that further formalizing representation through the introduction of elections is unlikely to remedy the limitations inherent in this voluntary model of PPI. 7,21 …”