Governance for health: Is the cultural ‘lone ranger’ behaviour still prevailing? Perspectives from policy-makers in Portugal

Abstract

Increasing attention has been paid to the significant role of governance in health policy-making. The goal is to develop health policies more responsive to local preferences and needs, in coordination with other policies, and adapted to the most suitable spatial scale. Rather than acting as isolated actors, health institutions must look at ways to strengthen collaboration in a cross-sectoral and symbiotic way with other actors. This article reports the health governance structure of Portugal, a country in which health has become a hotly contested topic due to recent pressures to reduce costs, yet claiming at the central level a whole society and government approach. Based on policy-makers' perspectives, this article explores how institutions interact in health policy-making at the national, regional and local levels. Findings suggest that health decision-making processes are still very centralised and focused within the health sector boundaries, symptomatic of a wider cultural problem.