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Regular version of the site

Health and Healthcare in Transition: Dilemmas of Governance

Academic Year
Instruction in English
ECTS credits
Course type:
Elective course
3 year, 4 module


Егоров Роман Вадимович

Course Syllabus


This course aims to familiarize students with modern healthcare systems, approaches to their management, as well as global new challenges. After completing this course, students will be aware of various healthcare systems, approaches to healthcare management, the concept of good governance and its specific aspects, such as public-private partnerships and public participation.
Learning Objectives

Learning Objectives

  • The goal is being able to analyze public health policy and evaluate changing social context.
Expected Learning Outcomes

Expected Learning Outcomes

  • Able to learn and demonstrate skills in the field, other than the major field
  • Student is capable of participating in organizing and implementing various management processes, and of achieving the goals set by his/her superiors: both as a rank-and-file participant and as a low-level manager; - in public administration, in political and business structures alike.
  • Student is capable of executing applied analysis of the political phenomena and political processes - by using political science methods - and in support of practical decision making process.
Course Contents

Course Contents

  • Healthcare Systems in the Contemporary World
    This lesson focuses on the main challenges and global shifts in the healthcare sector, which, in turn, create a demand for more systemic approaches to governance, management, and leadership. It appears to be difficult to differentiate these concepts (governance, management, and leadership) clearly due to their interrelations and complexity. This module will introduce different ways of defining and relating these concepts in order to illustrate challenges to finding a consensus between such definitions.
  • Definitions: Governance vs Management vs Leadership in Health
    History of the classification of health systems. The nature, purpose and limits of classification in comparative health policy.
  • Health as a Political vs Apolitical Concept
    Assessing health system governance and performance requires ethical reflection on the following questions: 1) Who is responsible for health? 2) Who are the beneficiaries? There are different approaches in seeking answers to these questions. Healthcare policies entail scientific data, technologies, and expert recommendations that can appear non-political, as well as cultural norms and respect to individual liberty. But, on the other hand, health can become political in the context of decision-making that entails the distribution of resources and the selection of priorities and modes of action. So, in this module we will delve into these complexities and will work to understand what stands behind health policy and governance decisions. We will take a look at different ethical concepts that may underpin political decisions on health governance, health care reforms, or demands for redistributive policies.
  • Public Participation vs Top-Down Steering
    On the one hand, citizens’ engagement in governance of health and health care is important for the transparency and responsiveness of decision-making, as well as for ensuring trust and cooperation. Moreover, often citizens themselves demand direct engagement, as exemplified by health activism: from local action to addressing environmental health risks, to global action on HIV/AIDS, and access to medicine. On the other hand, critics suggest that laypersons can add inefficiency, irrationality, and incoherence to health policy decision-making. There can be undesirable features in governance models heavily dependent on public engagement like interest-group competition in rule-making and the professionalization of citizen participation, where not all citizens are necessarily equally empowered to make contributions.
  • Focus on Whole-of-Society vs Focus on Health Services Provision
    Health governance is a field where the search for best solutions is continuous in all corners of the world. Health systems increasingly struggle with rising costs, ensuring adequate numbers of health professionals and providing access to the best life-saving treatments and technologies. You will hardly find a country that would not attempt to improve health system performance through reforming the health sector and improving health care delivery. But people’s health depends on multiple complex factors (from employment and work to transport and housing) and relates to social processes of industrialization, urbanization and globalization and to differential exposures to risks. Drivers of human health are not constrained to the health care system. Therefore, new and wider approaches to health governance appear: they are based on the idea of extending health governance from sectorial focus to the whole-of-society and whole-of-government level. These approaches argue that the improvement of a population’s health necessitates engaging non-health sectors and actors through policies and initiatives at all levels of governance, with or without the involvement of the health sector itself. This creates a dilemma for health governance: should it be focused on improving health service provision only, or embrace the whole of society and all sectors of governance?
  • De Jure and de Facto Dimensions of Healthcare Governance
    Quite often the identification of the gaps or problems in the health care system result in recommendations to change certain regulations, i.e. to adopt a new law, to make the changes in the existing law, to issue an order etc (de jure dimension). Indeed, the suggestion to improve regulatory dimension can be seen as a systemic approach because the behavior and practices take place within the specific existing structure. Therefore, regulations are seen as the efficient entry point that has an impact on the numerous practices. However, changing structures or policy development requires substantial resources, e.g. political support, time and expertise. Also, the rule of law in some countries can be low, meaning that even if the law is adopted, it is not necessary that it will be reflected in actual practices. Sometimes the results are poor not because of lack of law, but because people may simply be lacking knowledge, skills, competences in, for example, organization management. Therefore, introducing new regulations (de jure dimension) is not always the entry point for the new (more healthy, more effective, more transparent etc.) practices (de facto dimension). Thus, we discuss a dilemma related to inconsistencies and imbalance between the structures on the one hand, and practices on the other hand, as well as the challenges that arise when only one perspective (de jure or de facto) is taken into account. In this lesson we explore the dilemma between de jure and de facto dimensions in health care governance.
  • Change, Reforms and Stability in Health and Healthcare Governance
    The stability of healthcare systems can be equally as important as change, especially in systems that are performing relatively well. The issue of stability and change in sectors and institutions, including health care, is rooted in the socio-cultural and historical context of the country as well as in current capacities for change. We may see that some countries or systems are more inclined to change when compared to others. Indeed, health care reforms have occurred in most post-communist countries after the Soviet Union collapsed, however the healthcare systems of some of the ex-republics continue functioning as they were designed in the Soviet Union. Several decades ago stability was seen as one of the most essential values in this setting, while now nostalgic moods in some of the countries may partially explain difficulties in the implementing reforms. In this module we will illustrate the concepts of “stability” and “change” or “reform” by the case of changing tax-based and insurance-based mechanisms of health care system financing, and its performance under varying and transforming socio-cultural and health conditions. The transition in the post-communist countries of Central and Eastern Europe is taken as an illustrative context for the case.
  • Public-Private Partnerships in Healthcare Policy: the Role of Busyness and NGO’s
    The theory of sectors of society: state, business, civil society. Public-private partnership, public-private partnership, public-private partnership. Intersectoral social partnership in healthcare.
  • Moral Foundations of Healthcare Policy
    Philosophical and moral foundations of healthcare. Health models in various philosophical concepts: liberalism, socialism, utilitarianism, libertarianism.
  • Unsolved Problems of Healthcare Governance
    Who needs medicine, and who should take part in contemporary healthcare? Restricted access to medical care. Inefficiency of medical care. An aging population and an increase in the number of chronic diseases. Outdated systems for organizing and financing health care. Outdated management strategies and approaches.
Assessment Elements

Assessment Elements

  • non-blocking Online Course Assignments
    Assignments suggested by the MOOC
  • non-blocking In-Class Presentations
    Students prepare presentations (1 per a mini-group throughout the course) on a particular topic
  • non-blocking Essay
    An individual written paper on a particular topic
  • non-blocking Final Test
    The test consists of 20 closed and 5 open questions.
Interim Assessment

Interim Assessment

  • Interim assessment (4 module)
    0.25 * Essay + 0.25 * Final Test + 0.25 * In-Class Presentations + 0.25 * Online Course Assignments


Recommended Core Bibliography

  • Meadowcroft, J. (2015). Just healthcare?:The moral failure of single-tier basic healthcare. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edsbas&AN=edsbas.A84A84BD

Recommended Additional Bibliography

  • Elizabeth Docteur, & Howard Oxley. (2003). Health-Care Systems: Lessons from the Reform Experience. OECD Health Working Papers. https://doi.org/10.1787/865047648066
  • Karaeva, O. (2016). Perceptions of Fairness and Effectiveness in the Health-Care Systems of Different Countries (According to ISSP Data). Russian Social Science Review, 57(2), 86–116. https://doi.org/10.1080/10611428.2016.1159494
  • Tagaeva, T. O., & Kazantseva, L. K. (2017). Public Health and Health Care in Russia. Problems of Economic Transition, 59(11/12), 973–990. https://doi.org/10.1080/10611991.2017.1431488