The more health policies change, the more they change the same way

In a series of articles over the last 5 years, Richard Saltman, one of the foremost scholars in the field of comparative health systems has begun to question whether traditional pillars of these systems are in need of fundamental restructuring. In the wake of the financial crisis of 2008, Saltman argued for new modes of financing to cope with austerity, and re-examination of the concept of social solidarity. In a recent piece in this journal, he considers the challenges posed by the information revolution. This commentary raises questions regarding the particular impact of the information revolution as opposed to pressures that have beset health systems for several decades, and examines Saltman's policy prescriptions in light of previous attempts to restructure health systems. It is suggested that whatever the path forward for health systems, failure to address the cultural gap between medicine as a profession and medical managerialism explains past reform shortcomings and is likely to hinder any restructuring responses to the information revolution.