Theories of financialisation and health systems governance: a critical interpretative synthesis

Strong health system governance requires effective stewardship of private actors operating within health systems and ensuring that their activities align with a government's strategic health goals. Financialisation, defined as the expanding role of financial actors, instruments, and ideas, has been identified as a potential opportunity, but also challenge to health systems and their governance. There is a need to comprehensively understand how financialisation impacts both health systems and their governance. We initiated a critical interpretative synthesis of literature theorising financialisation of health systems or health system governance. A search was conducted to identify English-language, peer-reviewed and grey articles that (1) contains definitions or conceptual frameworks of financialisation; and (2) relates this concept to health systems or health-system governance. We found that articles defined financialisation as a transformative process characterised by the advent of private investors and financial instruments within health systems. We identified several emergent themes in the literature, such as the role of profits and competition in financialised health systems. Finally, most articles addressed potential challenges that financialisation raises for health system governance, especially accountability and transparency challenges. We conclude by considering how future research might address the remaining gaps within the literature.