Table 2 Governance dimensions affected... | Emerald Publishing

Table 2

Governance dimensions affected by sector

Governance dimensions	Social benefits	Renal care	Hospital service compensation
Strategic planning	No needs-based eligibility framework; benefit map fragmented	Strategic plan obsolete; care level definitions and territorial criteria undefined	System objectives misaligned with health policy directives
Resource management	Allocated resources insufficient; no adjustment mechanisms	Extrahospital pricing exceeded hospital costs; insufficient home-based treatment funding discouraged cost-effective modalities	Price determination lacked economic justification; providers grouped arbitrarily
Control systems	Monitoring absent; improper payments widespread. Externalised management lacked oversight frameworks	Billing validation inadequate: duplicate sessions detected for identical patients	Contract program not formalised; annual clauses signed after service delivery began
Intersectoral coordination	No coordination with local authorities; fragmented coverage	Lack of coordinated care pathways and shared protocols between hospital and outpatient nephrology services limited care continuity	Payment incentives conflicted with emergency care policy; multiple funding mechanisms created asset overfunding risks
Monitoring and evaluation	No systematic evaluation of policy impact or beneficiary satisfaction	Clinical outcomes unmonitored; user satisfaction not formalised	Provider payment timing inadequate; financial incentives ineffective
Transparency and accountability	Conflict of interest management inadequate; no transparency frameworks for partner entities	Procurement lacked documented justification; collusive indicators revealed; territorial criteria undisclosed	Service assignments made without documented or transparent criteria

Governance dimensions	Social benefits	Renal care	Hospital service compensation
Strategic planning	No needs-based eligibility framework; benefit map fragmented	Strategic plan obsolete; care level definitions and territorial criteria undefined	System objectives misaligned with health policy directives
Resource management	Allocated resources insufficient; no adjustment mechanisms	Extrahospital pricing exceeded hospital costs; insufficient home-based treatment funding discouraged cost-effective modalities	Price determination lacked economic justification; providers grouped arbitrarily
Control systems	Monitoring absent; improper payments widespread. Externalised management lacked oversight frameworks	Billing validation inadequate: duplicate sessions detected for identical patients	Contract program not formalised; annual clauses signed after service delivery began
Intersectoral coordination	No coordination with local authorities; fragmented coverage	Lack of coordinated care pathways and shared protocols between hospital and outpatient nephrology services limited care continuity	Payment incentives conflicted with emergency care policy; multiple funding mechanisms created asset overfunding risks
Monitoring and evaluation	No systematic evaluation of policy impact or beneficiary satisfaction	Clinical outcomes unmonitored; user satisfaction not formalised	Provider payment timing inadequate; financial incentives ineffective
Transparency and accountability	Conflict of interest management inadequate; no transparency frameworks for partner entities	Procurement lacked documented justification; collusive indicators revealed; territorial criteria undisclosed	Service assignments made without documented or transparent criteria

Source(s): Authors’ elaboration based on operational audit reports from the Sindicatura de Comptes de Catalunya