ABSTRACT
Healthcare is usually considered a social right. Different systems of healthcare delivery have been implemented in accordance with this perspective. Equity in access has been the paradigm of healthcare systems in many developed societies. However, the lack of economic sustainability and a higher demand for quality and safety have contributed to the introduction of new management modalities as decisive factors for modernization, innovation, and competitiveness in the health sector.
The health sector has followed the general trend of public administration to reinvent itself to meet citizens’ expectations of a more efficient, modern, and sustainable public management. However, a more responsive public administration implies the adoption of management mechanisms that are more accountable, as well as systemic changes at the level of strategic planning and overall political accountability. The steady debate between equity and efficiency has led to the introduction of rules and principles of new public management in the provision of healthcare. The government by contract is a paradigmatic example of this evolution. However, the search for efficiency has also led to the rise of healthcare regulations to monitor and enforce rules and guidelines.
