The Politics of Governing Mixed Health Systems: Coordination, Equity, and Accountability

Health systems contain diverse public and private actors that are involved in financing, provision, and governance. Inadequate coordination of these actors can fragment care, deepen stratification, sustain barriers to effective access to care, and produce inconsistent service quality. Coordination mechanisms—including performance-based contracting, streamlined regulatory, monitoring and evaluation systems, and social participation—are potential tools to align actors around public health goals and to promote universal access to quality care. Yet their effectiveness depends on political and institutional contexts, and little is known about how different configurations interact. This panel examines coordination mechanisms in mixed/plural health systems across high-income countries and low-and-middle-income countries. A special focus of the panel is social participation as both a coordinating mechanism and a vehicle for democratic strengthening. We invite theoretical papers that advance analytic frameworks for coordination in mixed systems, alongside empirical and comparative studies that examine design, implementation, and outcomes. We are particularly interested in how contextual factors, including policy capacity, institutional history, political culture, and policy paradigms, shape these processes.