The State and medicine in the governance of health care in Portugal

Abstract

According to Newman (2005), the way the state, public and private stakeholders, the health professions and the market connect with each other determines the structure of governance in health care in each particular country. This concept stresses a more complex and diversified set of regulatory mechanisms and practices than those provided by the broad typologies that divide Western health-care systems into national health services (the Beveridge model), social security systems (the Bismarck model) and private health insurance systems (the market model) (see van der Zee & Kroneman 2007 for a synthesis). Countries sharing the same typology may actually reflect different governance arrangements, depending on the threefold articulation between the state, the professions and the market. In some cases, network-based governance has pride of place (the Netherlands or Norway); in others that key position is taken either by the state (the United Kingdom) or health professionals (in which case medicine may stand alone (Germany) or be obliged to negotiate with other health professions (Denmark)) (Burau & Vrangbæk 2008).