Health Professionals, Health Policy and Health Management Theory: The Big Disconnect

In tandem national health system reforms in Western countries, management theories seeking to adapt health organizations to policy directions have evolved. Unfortunately, policy directions and management theories appear distant from the socialization of health professionals, and, as a result, relatively little change has taken place in the organization of health care delivery. This paper will combine several sources of information to paint a picture of the disconnect between health professionals and health policy and management. The first source is a review of the literature on the knowledge and attitudes of health professionals, especially physicians, towards health reforms and managerial interventions such as quality measurement and health information technology in different countries including, but not limited to, the US, France and Israel. Second, the author will report on empirical research ongoing in Israel on two main subjects: 1. how physicians, nurses, managers and policy makers view efforts to measure the quality of health care and report the results to the public, and 2. the process of introducing ehealth and mhealth into the Israeli health system and how this process is viewed by physicians, managers, policy makers and citizens/users.  Third, the author will report on a bibliographic study of articles on health policy and management appearing in major medical journals such as JAMA and NEMJ using citation analysis to show that such articles are not, by and large, read by clinicians. While the overall hypothesis of this complex of research projects is that health professionals have been disconnected from the design and implementation of health policy and management innovations, the study will also test the hypothesis that countries with strong traditions of physicians and other providers working within the framework of National Health Services or large managed care organizations will be characterized by relatively greater health provider understanding, acceptance and implementation of managerial innovations linked to national health reforms.