The logic of governance in health care delivery

A multi-level analytic framework termed a ‘logic of governance’ is used to identify systematic patterns of health care governance from the findings of disparate research studies. Using a subset of 112 studies on health care service delivery, we use an ‘inside-out’ interpretive strategy to construct an empirical overview of health care governance. This strategy incrementally aggregates findings from studies of adjacent then of non-adjacent levels of governance until a coherent overall picture emerges. In general, the choices of organizational arrangements, administrative strategies, treatment quality and other aspects of health care services by policy makers, public managers, physicians, and service workers, together with their values and attitudes toward their work, have significant effects on how health care public policies are transformed into service-delivery outputs and outcomes. Investigations that fail to account for such mediating effects in research designs or in the interpretation of results may provide inaccurate accounts of how health care governance works.