New Governance Practices in U.S. Health Care

The problems of the uninsured, cost escalation, and improving quality in United States health care are once again on the front pages. There is a sense that these problems can be resolved despite the magnitude of the issues. This optimism is related to new techniques and approaches to governance. This new approach is called "new governance" and includes devolution, public-private partnerships, stakeholder collaboratives, network creation, coordinated date collection, benchmarking and monitoring. This paper examines the way new governance tools are being incorporated in resolving health care problems. The first section discusses stakeholder collaborations, the arenas in which leading actors are developing ways of dealing with three health care conundrums: how to embed technology, how to eliminate racial and ethnic disparities, and how to achieve universal coverage. The paper then describes how the effort to resolve these problem areas moves from traditional regulation to a different set of strategies. The first shift is in the strategy for embedding technology from command and control to standard setting and local collaborations. The second example is the shift in eliminating racial and ethnic disparities from anti-discrimination litigation to quality assurance tools. The final example is the shift to envision universal coverage from a centralized single system to linked state experimentation. The paper concludes with a discussion of how regulation and governance must be rethought to allow these emerging practices to resolve the health care conundrums