Health management education in Europe and in the United States: a comparative review and analysis

In Europe and in the United States, health management education and the role of health managers are patterned and consistent with how the country's healthcare system is organized, managed, and financed. In the United States, the fee-for-service, entrepreneurial dominated approach, resulting in health being one of the few remaining growth industries, has created a huge demand for additional health management education programs and managers. Therefore, universities finding themselves in an economic slump are attracted to establish health services administration programs (a North American term) since they require limited capital, continue to attract enrollment, and contribute to the "social good." In contrast, the European countries' healthcare systems provide universal access to care and strict, governmental fiscal control on healthcare expenditures. As a result, the American masters-level health manager model has not thrived there--although not willingly conceded is the fact that in Europe physicians continue to dominate the management ranks. After outlining a number of the current problems facing US health management education, this article focuses on: (1) a projected shuttering of the weaker American health management programs and the market for health managers being overly saturated (such as for lawyers now), because the US gross domestic product expenditures for health will decrease over the next two decades from the current level of 17.6% to be somewhat comparable to the 11.5% in Canada, France, and Germany; and (2) a projected increase in the enrollment among European health management programs for several reasons: (a) a huge spike in the demand for additional clinically oriented, health managers who can trade off concerns of cost versus quality; and (b) the constraints of most countries' statutory health insurance plans will become increasingly more evident so that privatization of healthcare services will become an option for those with above average incomes and, thereby, generate a demand for newly minted health managers similar to the US masters-level graduate.