Management without frontiers: health system convergence leads to health care management convergence.

Health care managers and policymakers throughout the industrialized world are faced with a variety of new challenges at the same time that traditional constraints on action are becoming ever more restrictive. These pressures have stimulated a variety of health care reforms involving four different strategies for change: cost-containment efforts, quality and administrative efficiency improvements, cost-shifting efforts, and the adoption of market-related concepts from the private sector. These changes are leading to convergence among health systems, as seen by the reforms underway in the Netherlands, Germany, and the English component of the United Kingdom's National Health Service. This in turn will create convergence in the problems and issues faced by health care managers. Issues such as hospital contracting, managed mental health care, primary care gatekeeping, and four others are explored to illustrate how American managers can learn from the experiences of colleagues in other industrialized nations. A final section identifies common themes for health care executives in this period of global convergence.