The second health policy paper of the year has been published, by Vicente Ortún, titled: “Governance and management of healthcare organizations.”

Available on-line: https://hdl.handle.net/10230/72600

It argues that the sustainability of Spain’s public healthcare system depends less on having more resources or undertaking structural reforms, and more on a profound improvement in the governance and management of healthcare organizations. The author contends that the quality of the system is shaped more by the design of incentives, responsible autonomy, managerial professionalization, a clear separation between governance and management, and accountability than by whether centers are publicly or privately owned.

Empirical evidence does not show systematic superiority of any organizational model, and emphasizes that the key lies in the governance framework, the institutional contract, and the competitive environment. Given the difficulty of large-scale reforms, it proposes a strategy of “selective radicalism” (deep but bounded changes), grandfathering in human resources, and learning from COVID-19 (flexibility, clinical leadership, less bureaucracy), with initiatives such as CAIROS as an example of organizational innovation oriented toward population health outcomes and social value.