Misaligned Stakeholders and Health System Underperformance

Misalignments in health systems (i.e., situations involving conflicting incentives, behaviour, structures, or policies) among key stakeholders are likely to lead to significant waste, whether measured in terms of health for money or money for health. This white paper defines three types of misalignments (those due to divergent objectives, power asymmetries and cooperation failures), offers concrete examples of each type and includes several cross-cutting examples from three particularly burdensome disease areas: cancer, diabetes and mental health. Situations in which stakeholders acted to correct misalignments and reduce waste are also presented through several case studies of achieving greater alignment. The paper enumerates a set of lessons for stakeholders and concludes by making recommendations for future research in this domain.

Click here to read this white paper, authored by GHP Professor David Bloom, and GHP research staff members Jessica Sullivan and Daniel Cadarette, among others.